Measuring the impact of medical research: moving from outputs to outcomes.

Billions of dollars are spent every year to support medical research, with a substantial percentage coming from charitable foundations. To justify these expenditures, some measure of the return on investment would be useful, particularly one aligned with the intended ultimate outcome of this scientific effort: the amelioration of disease. The current mode of reporting on the success of medical research is output based, with an emphasis on measurable productivity. This approach falls short in many respects and may be contributing to the well-described efficacy-effectiveness gap in clinical care. The author argues for an outcomes-based approach and describes the steps involved, using an adaptation of the logic model. A shift in focus to the outcomes of our work would provide our founders with clearer mission-central return-on-investment feedback, would make explicit the benefits of science to an increasingly skeptical public, and would serve as a compass to guide the scientific community in playing a more prominent role in reducing the efficacy-effectiveness gap. While acknowledging the enormous complexity involved with the implementation of this approach on a large scale, the author hopes that this essay will encourage some initial steps toward this aim and stimulate further discussion of this concept.