Overview of Outcomes Research
Outcomes research entails the application of clinical- and population-based research methods to optimize the end results of health-care practices and interventions, delivering benefits and value to stakeholders.1 Widely used in human health care, outcomes research principles can assist health-care providers and their patients in making decisions regarding medical costs while weighing available treatment options. The overarching goal of health-care providers should be to achieve clinical outcomes and improve value for patients. Value, however, is not the same as low cost. Porter and Lee2 defined value as the health-related outcomes that matter to patients relative to the costs incurred by reaching those outcomes. They proposed a “value agenda” toward shifting the focus of health care to maximizing value for patients rather than a focus only on profitability when the latter is linked to the volume of services rather than quality.
Although the discipline of outcomes research has been developed and broadly applied in the human health community,1,3 its formal implementation for addressing animal health issues, though increasing in the last decade, has been limited. With a goal of improving effectiveness and efficiency in animal health care and its associated impacts on human health, outcomes research activities in veterinary medicine demonstrate the value of animal health interventions, including treatment, prevention, management, or diagnostic activities that are intended to improve health. By explicitly defining and incorporating knowledge of both the potential effectiveness of an intervention and the economic, societal, or client values inherent to the application of the intervention, the potential impacts of health-care decisions can be optimized for a given situation.1
In recent years, the animal health-care sector has faced several challenges, including an increase in costs of veterinary services and a decline in access to veterinary care at a time when many animal populations are steady or increasing. Of concern is whether patients are getting adequate veterinary care, and pet owners or producers are being presented with value-based options for decisions involving animal care.
Comparable to the rise in volume of services and spending observed in human health care, expenditures in veterinary-related services have increased in both the companion animal and food animal sectors. As the percentage of households with pets in US steadily increases, from 57% in 20164 to 67% in 2020,5 the total household expenditures related to veterinary care and product sales have also increased—estimated to be $28 billion in 2016,4 $31.4 billion in 2020, and $32.3 billion in 2021.5 The fact that over 63% of owners consider their pets to be family members,4 coupled with the augmented lifespan of pets given the advancements in knowledge and technology in veterinary medicine and the ample evidence of the beneficial health effects of the human-animal bond, it is not surprising that owners have increased the time spent with their pets and their concerns about keeping them healthy.6 There is substantial evidence regarding the beneficial effects of owning a companion animal, especially under stressful conditions.7 The human-animal relationships established during the ongoing COVID-19 pandemic highlighted the physical, mental, and well-being benefits experienced by pet owners.8,9 As social restrictions increased, a surge in pet adoptions was observed. In fact, the number of adoptions, as percentage of animals brought into shelters, rose by 8.3% from 2019 to 2020.10
In food animal production systems, veterinary care is crucial to prevent contagious animal diseases and zoonoses as well as to maintain animal health and welfare. In turn, veterinarians protect the livelihoods of farmers and safeguard the food supply.11,12 Because of the pressure to increase food supply due to the rapid growth of the global population, larger gaps in veterinary care are projected to occur in communities that already may have inadequate access to veterinary services.13,14 The provision of veterinary services goes beyond the diagnosis and treatment of diseases, extending to responsibilities concerning biosecurity and other preventive measures that can increase productivity and profitability of livestock operations.
Despite the increase in the pet population and increasing production of animal protein observed in recent years, there has been a substantial reduction in access to large and companion animal veterinary care.12,15 Considering routine checkups unnecessary, growing veterinary costs, and increased financial limitations of owners and managers are deemed to be the 3 most important client-driven factors responsible for the decrease in veterinary visits or services and for negatively impacting the ability of veterinarians to provide quality of care.12,15–17 Among pet owners, expectations exist that the welfare of animals should take precedence to cost considerations, yet paradoxically, clients have expressed dissatisfaction regarding the little to no information about costs received during veterinary visits.18 For livestock operators or managers, a commonly reported problem relates to limited access to local veterinarians. Recent veterinary graduates are becoming more specialized and focused on small animal practice, partly because of the potential for financial stability with this type of practice and the graduates’ unfamiliarity with rural practices and lifestyle, creating shortages of food animal or public health veterinarians for rural communities.13,14 Other reported problems include a delay in obtaining services and costs of veterinary services being high relative to the economic value of the animals.19,20
Research to support current health-care recommendations, clinical practices, and interventions that are medically ineffective or not cost-effective is often not readily available. By identifying and quantifying the cost-effectiveness and value (health, economic, and client-perceived) of diagnostic and therapeutic practices, health management decisions can be optimized for patients, clients, and practitioners. Clinicians and clients can then target available resources for needed care and discuss a portfolio of cost-effective options, allowing clinicians and owners to make informed decisions about veterinary care practices and products offered, given client preferences, associated costs, and health risks. Clinicians and veterinary practitioners would then benefit from applying outcomes research principles and methods to the wide spectrum of services in veterinary medicine.
Whereas traditional clinical trials or evidence-based medicine may focus primarily on intervention efficacy or safety, outcomes research approaches may consider additional parameters such as cost, timeliness, convenience, quality of care, and patient and client preferences as well as the value of general health-care strategies. Thus, evidence-based medicine and outcomes research are not synonymous, but are complementary.21
Broadly speaking, outcomes research in veterinary medicine spans both the clinical practice spectrum encompassing benefits to an individual patient or client in a specific situation (micro impacts or micro level) and the macro-level spectrum in which health-care practices or interventions may benefit a larger population of animals or society (macro impacts or macro level). A meso level has also been described to address effectiveness, clinical modeling, and program evaluation studies.22
At the micro level, the value of interventions is usually determined by the individual—the animal owner, the consumer, the farmer or producer, or the veterinary practitioner. When referring to pet-related health interventions, such as those intended to benefit the quality of life (QOL) of companion animals by managing chronic diseases, decisions are based on emotional and medical value, as determined by the animal owner and the practitioner.23–26 Outcomes based on economic value as perceived by a livestock producer derive from monetary gains (or losses), such as vaccination interventions aimed at disease prevention (Escherichia coli infection in cattle27). Consumers also may be at the center of decision-making when their preferences and choices determine the focus of outcomes research, as is the case with food safety standards that arose from the bovine spongiform encephalopathy crisis in cattle.28 At the macro level, where value is determined by policy makers, the industry, or the government, outcomes research is often directed toward public health challenges, which include zoonoses and issues affecting both animals and humans, but also animal diseases with great economic or societal impacts (eg, toxoplasmosis in humans,29 Campylobacter infection in poultry,30 or foot-and-mouth disease in cattle31). Although at this scale outcomes research approaches consider economic and other cost-related measures, they tend to focus on measures of effectiveness or other potential benefits to the populations of animals or people. For instance, the depopulation of infected herds could be the most effective way to eradicate foot-and-mouth disease virus in some scenarios, but this mitigation strategy may not be optimal when impacts on animal and economic resources are holistically considered.32,33 Finally, meso-level studies address the effect of health-care services on disease outcomes, including the impact of disease traits, screening, or diagnosis. Although smaller in size than macro-level studies, meso-level studies can be descriptive or analytic and pertain to effectiveness, variability in performance, or decision analyses studies, among others.22
The purpose of this article is to introduce the veterinary professional (large, mixed, or companion animal) to the origins and evolution, principles, methods, and impacts of the discipline of outcomes research as well as to discuss opportunities for application and enhancement of outcomes research approaches to benefit veterinary medicine and society. By providing a comparative approach of the application of outcomes research across species, we aim to engage practitioners across different fields to relate and leverage similarities and differences among species when applying outcomes research methods to enhance veterinary medicine.
Origins and Evolution of Outcomes Research
The field of outcomes research may be relatively recent, but the timeline of events that led to the establishment of the discipline began in the early 1900s. A surgeon from Harvard Medical School and the Massachusetts General Hospital, Ernest Codman, was leading an effort for hospital standardization,34 advocating for a patient-tracking system to allow for the comparison of the effectiveness of treatments between hospitals.21,34,35
In 1966, Avedis Donabedian introduced the term outcome as part of his framework for the quality assessment of medical care. He used outcome to describe the consequences of care.36 In 1972, A. L. Cochrane clarified a number of key concepts in outcomes research as part of his work on the effectiveness and efficiency of health services.37 As part of his 1988 Shattuck lecture, P. M. Ellwood coined the term outcomes management to describe a management tool to help patients, payers, and providers make more informed medical care–related choices.1
Outcomes research as a discipline was first highlighted by Clancy and Eisenberg in their 1998 article in Science.3 They noted a lack of uniformity in medical treatments for patients with the same condition. These authors further suggested that extensive inquiry into the differences in the process of care that are associated with more effective outcomes will allow clinicians and organizations the opportunity for improvement and patients the opportunity to make informed treatment choices. They also recommended that clinical decisions consider different outcomes, such as survival length and QOL, rather than the traditional measures of clinical success or failure, such as mortality and measures that act as surrogates for physiologic function.
Since the Clancy and Eisenberg article3 was published, the discipline of outcomes research has been formalized. The Professional Society for Health Economics and Outcomes Research (ISPOR)38 was founded in 1995 as an international multidisciplinary organization to advance the policy, science, and practice of outcomes research.38 Multiple centers of outcomes research have also been established in association with universities and medical centers, including the Patient-Centered Outcomes Research Institute39; Center for Outcomes Research and Evaluation, Yale School of Medicine40; and the Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health41. Outcomes research has experienced substantial growth in specific fields of medicine, including cardiovascular disease and oncology.38,39,42 This organization of the field has provided direction and a forum for discussion of outcomes research application in human health care.
Impacts and drivers of outcomes research
Outcomes research makes it possible to identify optimal care for a patient, with integration of research into health-care delivery being at its core. The field of outcomes research addresses questions such as “What should we be doing to put patient care first?” and “What is the value of this treatment?” Evidence-based medicine can be used to classify or stratify patients into risk groups which will have an impact on the treatment that is recommended. Patient-specific recommendations are then possible due to accounting for the heterogeneity of treatment effects, which can be explained by demographics, genetics or biology, and clinical (comorbidities), behavioral (compliance), and socioeconomical or environmental factors. These are the factors that must be considered as we approach an era of personalized medicine.43 Outcomes research includes assessment of diagnosis or treatment approaches, which can then be integrated into the workflow of a hospital or organization for effective clinical application. The future of outcomes research in human health is, therefore, the move from preventive to predictive care or predictive models of therapy, allowing for a proactive rather than reactive response based on lessons learnt.43 Depending on the outcome of interest, there are a number of different types of analyses that can be performed within outcomes research to address these issues. These include the assessment of follow-up care (risk-standardized survival rate analyses), cost-effectiveness analyses, QOL analyses or mixture models/latent class analysis which can assist with the identification of patients that have similar outcomes (eg, those unresponsive to treatment43).
Illustrative of the challenges above are phase III trials (clinical trials that are in full development), where patients with certain baseline characteristics may be excluded, such as older patients or patients with particular comorbidities, making it difficult to measure the real-life effectiveness of drugs.44 To rectify this problem, programs such as HOPE (Health Outcomes Performance Estimator) were established to predict real-life outcomes. The integration of heterogeneous data into a predictive model and optimization of the collection of population-specific missing data will contribute toward pragmatic trial design. Bridging the gap between efficacy and effectiveness, outcomes research measures the interaction between drug use factors (eg, patterns of use, dose, treatment duration, history of exposure, or coprescriptions) and patient population factors (eg, age, gender, comorbidities, disease stage, or genetics).45
Previous applications in veterinary medicine
Although outcomes research has been applied in veterinary medicine, studies so far have not been explicitly termed as such. Examples of outcomes research applications in veterinary medicine expand to a wide range of subjects and include efforts to align veterinary health care with human health practices. The following topics are not intended to be an exhaustive review, but to provide examples of previous applications of outcomes research in veterinary medicine. It is important to note that, given some studies evaluate a multitude of outcomes, overlap among topics may exist.
Outcomes assessment tools in veterinary medicine
Various tools to help veterinary health professionals assess different types of outcomes have been developed and/or adapted from other disciplines. Shaw et al46 have discussed the use of a nonmonetary metric based on life years lost and disability to assess illness in animals. This metric was developed to relate economic losses due to animal disease to an animal loss equivalent, thus providing a viable option for choosing the most adequate programs for controlling zoonoses. The animal loss equivalent metric may be estimated considering how much one is willing to pay for animal health or the replacement time value for animals with intrinsic emotional value, such as pets. Similarly, the zoonotic disability adjusted life year is an adjusted indicator that estimates the burden of disease attributed to zoonoses for both humans and animals, considering their societal burden.47
Quality-of-life assessments, traditionally used in social, psychological, and medical applications, have been developed and evaluated to be used as tools in clinical decision-making in dogs48–50 and horses.51 Mwacalimba et al50 demonstrated that a QOL survey, in addition to monitoring health and wellness, can facilitate communication between clinicians and dog owners regarding preventive care and services, as well as increase client treatment compliance and client satisfaction. Instruments such as the Canine Outcome Measures Program have been developed to assess not only QOL, but also safety and function in dogs undergoing orthopedic procedures.52
In assessing health-related QOL in dogs, an online questionnaire has been validated to measure overall health or the progression of disease in sick animals.25 This tool can be used generically, or it can be disease specific (eg, to assess osteoarthritis26 or cancer in dogs53), and it can be useful in different clinical settings and for different purposes, including chronic disease management, owner compliance and engagement, and clinical trials and research.25 Recently, QOL tools also were deployed to assess the detrimental physiological and psychological effects that COVID-19–related restrictions have caused in companion animals associated with the social, environmental, and lifestyle changes observed during the COVID-19 pandemic.54,55 Such assessments can assist communication between clinicians and owners regarding decisions about veterinary care when owners have to cope with changing lifestyle and financial situations. Lastly, for estimating the intangible elements of emergency animal diseases, Wilson et al56 described a framework that addresses the full impacts of emergency animal diseases, rather than just the monetary losses. These are quantified according to the trade-offs that stakeholders are willing to make under different disease control scenarios and constitute another outcomes research tool that can be used in veterinary public health.
Evaluating scenarios using more robust measures of outcomes, regardless of the scale, can help caregivers and stakeholders make better-informed decisions about the available care or control programs. Pantaleon57 highlights the importance of measuring outcomes, especially considering owner-reported outcomes, for improving veterinary patient care.
Animal management practices to optimize outcomes
Management programs have been developed and evaluated to standardize animal care to optimize animal health and production efficiency. Management programs that emphasize rigorous employee training58 and the implementation of standard operating procedures of animal care59 have been positively correlated with improved performance outcomes in both beef and dairy cattle. The implementation of best management practices at the farm or slaughterhouse level aimed at the reduction of zoonotic foodborne pathogens is an example of outcomes research being conducted in veterinary public health.60 Furthermore, Vellinga et al61 used a simulation model to assess the association between husbandry and management practices with the cost-effectiveness of mitigation strategies for the reduction of greenhouse gas emissions in dairy production.
Public perception and communication
Selecting appropriate interventions, systematically assessing patients’ well-being, and discussing medical care options are part of the outcomes research process. This is an ever-evolving process that depends on medical advances, availability of resources, and changes in public perception and expectations regarding veterinary care and practices. For the latter, evaluating client perceptions of treatment options and public perceptions of general animal health care and communicating appropriate options for care, while considering client concerns and preferences, are key to effectively implementing outcomes research principles.
Studies that investigate client preferences about treatments for their animals can give veterinarians insight for making recommendations that have greater compliance rates and economic returns.24,62,63 Studies that investigate the public perception of the animal health industry can lead to tools to help facilitate communications between the veterinary profession and the public.64 By utilizing feedback from clients and the general public, veterinarians can maximize the positive impacts on their patients and clients, improve client communication, and meet the changing consumer demand of pet owners and clients in the current marketplace.
Economic value of interventions
Many types of economic studies in veterinary medicine can be classified as outcomes research. Quantifying the economic value of health-care interventions65 or the loss of economic value due to disease23 helps in directing the allocation of often limited resources in animal health. This can be achieved by using quantitative measures that include risk assessments, mathematical modeling approaches, and economic analyses.60
Randomized controlled trials have been performed in cattle to study comparative health and performance as well as to assess economic outcomes for multiple interventions, such as antimicrobial metaphylaxis practices for reducing bovine respiratory disease66 and interventions to reduce fecal shedding of E coli O157:H7.67,68 Simulation models and translational research methods (ie, systematic reviews of the literature and meta-analyses) also may provide information on the economic impacts of different interventions, such as metaphylaxis,69 bovine respiratory disease treatment,70,71 or E coli vaccination.27 Another example of outcomes research in veterinary medicine includes the estimation of indirect costs of foot-and-mouth disease using an econometric method to better allocate resources and for sector cost-sharing purposes.31
Determining the cost-effectiveness of various medications and treatments also can influence clinical decisions and recommendations as well as optimize the overall medical experience for both the veterinary patient and the client.23 Furthermore, determining the cost-effectiveness of medical interventions affecting public health can inform policy and direct funding for optimal interventions.72,73
When assessing the cost-effectiveness of different interventions, outcomes of interest may be life years gained, risk reduction, or sensitivity of a diagnostic test.73 Several studies have been published reporting interventions in which cost-effectiveness analyses have been performed for the above-stated reasons (ie, strengthen or optimize clinical decisions, better allocation of resources, and inform and advise stakeholders or policy makers for funding purposes), especially for addressing animal health, food safety, and public health issues. Examples are abundant in the literature and make use of different modeling strategies. These include 1) the assessment of control programs for Salmonella spp in pigs and dairy cattle,74–76 Johne’s disease in dairy cattle,77 and Campylobacter infection in poultry30; 2) disease introduction (eg, Aujesky’s disease78 and classical swine fever in pigs79); 3) disease surveillance (eg, avian influenza,80 bluetongue in cattle and sheep,81 and bovine spongiform encephalopathy in cattle and Creutzfeldt-Jakob disease in humans28); and 4) antimicrobial resistance (Campylobacter spp in poultry82). In small animal practice, a cost-effectiveness analysis has been performed to compare different drugs for treating canine heart disease.23 Another area where economic approaches have been implemented includes new communication technologies, such as telemedicine veterinary consultations, launched in response to the changing consumer demands of pet owners.83 Quantification of willingness to pay pointed to specific attributes needed to offer telemedicine in companion animal veterinary practice.63 The application of outcomes research, including the use of cost-effectiveness and willingness to pay, among other approaches, to assess client shopping behavior, can be beneficial for veterinary clinicians to facilitate decisions about adjusting product retail and service offerings as well as to determine how veterinary costs of medical recommendations are associated with owners’ decisions to seek, continue, or discontinue pet care services or products. Demonstrating the value of recommended veterinary care practices can enable clinicians to provide cost-effective evidence- and outcomes-based recommendations to owners, enabling continuity of care.
Additional examples of nonmonetary outcomes
End results of patient care also include nonmonetary outcomes that need to be considered, such as burden and frequency of disease, animal welfare ranking measures, antimicrobial use metrics, vaccine coverage of human or animal populations, or disease transmission rates. Although several nonmonetary outcomes specific to animal health issues are of great relevance (eg, survival of cancer patients or QOL), those that are also shared with people and their environment affecting one health are of upmost importance to public health and have gained momentum in recent years. However, because these outcomes are sometimes difficult to measure, and considering that interventions falling under the one-health umbrella have been scrutinized for their lack of accountability, tangible quantitative measures help to demonstrate the added value and cost-effectiveness of such interventions.60
Specific examples of one-health approaches include rabies interventions (vaccination of dogs or wildlife) measured in terms of outcomes that are monetary (cost of postexposure prophylaxis in humans) or nonmonetary (reduction of the number of cases in dogs and humans, avoiding the extinction of wildlife due to large outbreaks)84–86 and vector-borne interventions, evaluated in terms of their cost-effectiveness or their impact on zoonotic disease transmission.60 A social cost-benefit analysis of interventions focusing on the prevention of toxoplasmosis has been described in the literature, considering reduction in disability adjusted life years and monetary cost as outcomes, thus providing information to policy makers on the most beneficial interventions.29 Similar outcomes research has been performed looking at brucellosis in cattle and humans72 and parasites in humans and pigs.87
Opportunities and potential impacts in veterinary medicine
Drug development in animal health in comparison with human health is considerably smaller in size and profitability. As profit margins continue to decrease, the animal health industry could benefit by performing clinical trials for efficacy concurrently with effectiveness and economic analyses.88 These areas are the cornerstones of outcomes research (and pharmaco-economics) in human health and constitute a gap that remains to be bridged in animal health. One such example is the role of predictive modeling of consumer behavior and the economic impact of introducing a new product (eg, a generic brand) toward better preparing companies in response to changing market conditions. A modeling technique that addresses this is budget impact analysis (BIA), for which there are ISPOR guidelines available in human health.89 Whereas not yet described for animal health, there are several examples of the implementation of BIA and integration of BIA in economic analyses in human health. Examples include a BIA of tumor necrosis factor-α inhibitors in the treatment of rheumatoid arthritis90 and combining a BIA and a cost-effectiveness analysis to evaluate the budgetary impact of a new drug when assessing reimbursement of drugs.91 Similar predictive modeling would benefit the animal health industry with pricing and help with responsiveness to the introduction of competitor products on the market.
Research tools are publicly available on the ISPOR website pertaining to methods on clinical outcomes assessment, economic evaluation methods, statistical methods for health-care research, comparative effectiveness methods, patient-reported outcomes, and clinician-reported outcomes methods, through good practices, guidelines, and references.38 These, however, are focused on human health, and for the methods we have described, there are very few guidelines available on the application of these methodologies to animal health. Though these principles can be directly applied to animal health, some are partially driven by factors that may not apply in the animal health arena (eg, the pressure for human health products to be listed on formularies, which drive the types of analyses performed92). The adoption of methods, and development of corresponding guidelines, that can benefit product development in veterinary medicine are areas for potential growth in animal health.
Traditionally, research with the aim of demonstrating that one treatment is superior to another or to a placebo is performed to determine clinical efficacy. Clinical efficacy examines the performance of a treatment in a clinical trial environment that may not necessarily reflect the external circumstances (ie, external validity) under which the product will be used. Effectiveness accounts for these real-life external circumstances—that is, a broad range of clinical conditions and patient populations. Variations in outcomes with attention to demographic, biological, clinical, social, economic, geographic, and other factors are also evaluated.39 Assessing both clinical efficacy and effectiveness would provide more information than traditional randomized controlled trials measuring efficacy alone. This would make the evaluation of marginal benefits possible, as they affect decision-making at the individual and societal levels.93 Clinical effectiveness in conjunction with more pragmatic nontraditional clinical trials is being explored as part of a European initiative called IMI (Innovative Medicines Initiative) – Get Real Project. Results from this initiative have started to be shared with the public on the relationship between trial design and the ability to measure real-world effectiveness.45,94
Overall health-care spending, value-based alternative payment models, and price transparency are within the top 10 health economics and outcomes research (HEOR) trends of 2020, pointing to issues of interest for HEOR professionals that span health care across the globe.95 With an increasing pet population, increases in technology and sophistication of veterinary treatments available, and concerns regarding access to veterinary care, pet insurance represents a way to lower some of the affordability barriers related to veterinary services. The pet insurance industry now includes 20 companies in North America, 3.45 million pets ensured at the end of 2020, and a yearly average growth of 23.4%.96 Despite coverage being available in the USA for several decades, pet insurance penetration is currently a few points shy of 2% in dogs and cats, compared with higher percentages observed in England (approx 40%) and Sweden (approx 60%).96,97 Undeterred by its slow development in the US, insurance claims are already on the rise, regionally and globally.96,98 Discussions about the sustainability of this industry are being held in the UK, which has a robust health insurance marketplace, driven by concerns related to large bills for relatively healthy pets, the application of unnecessary diagnostic tests, and the use of cutting-edge methods in cases that do not need it, among other factors.99 Although pet insurance can help absorb or offset the increasing costs associated with veterinary care, health insurance costs directly depend on prices set by clinicians or practitioners for their products and services. The application of outcomes research can provide comparative evidence among veterinary procedures and therapeutic options that determine health-care spending and can prioritize those that improve pet health outcomes and provide the most value.
As the discipline of outcomes research gains traction and relevance across universities and medical centers, new initiatives related to animal health also have been developed. The Center for Outcomes Research and Epidemiology (CORE)100 has been established at Kansas State University’s College of Veterinary Medicine as an interdisciplinary research and training center for outcomes research in animal health.100 The first center of its kind in a veterinary college, CORE was instituted to raise awareness of outcomes research methods in veterinary medicine; to work in collaboration with practitioners, universities, and companies on outcomes research; and to provide educational and training opportunities. Similarly, during the ISPOR European conference in 2019, a forum called “Animal health—new kid on the HEOR block?” was organized by a group of industry and academic leaders in the area of outcomes research in animal health, with the purpose of introducing conference attendees to this outcomes research application as well as gauging membership interest in an animal health–one health special interest group.101 As the field of outcomes research grows in animal health and the veterinary profession, other formalized initiatives should also evolve.
Closing Remarks
Because animals are important to our society, more and more veterinary clients desire higher standards of care for their animals, while they concurrently consider costs and risk trade-offs. Hence, veterinary care providers should strive to continually demonstrate value of health practices for patients and clients. To improve the effectiveness and efficiency in animal health care and its associated impacts on human health, health interventions—including treatment, prevention, or diagnostic activities—should be optimized based on demonstrated value.
There are many aspects of veterinary medicine that could be considered under the heading of outcomes research, but an intentional effort has yet to be made to harmonize the work being done in this area. This alignment could provide systematic, transparent, and validated approaches to more comprehensively optimize animal health care and any associated impacts on human health. Human health care has moved toward patient-specific recommendations by considering the heterogeneity of treatment effects and the progression from preventive to predictive care or predictive models of therapy. In animal health, this could translate to treatment recommendations that consider genetics (eg, breed) as well as age, weight, and comorbidities of the animal patient. Similarly, there are potential benefits of incorporating clinical effectiveness studies with pragmatic nontraditional clinical trials as has been observed in human health. In conclusion, the development and systematic application of valid outcomes research approaches would enhance the ability of veterinary professionals to quantify the value of animal health interventions, leading to more informed stakeholders and clients and optimal care for veterinary patients.
Acknowledgments
No third-party funding or support was received in connection with this study or the writing or publication of this manuscript. The authors declare that there were no conflicts of interest.
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