Outcomes History
Although he is more known for his work on the shoulder in the field of Orthopaedics, E.A. Codman (1869-1940) is widely regarded as the "father" of Outcome Research. Codman was the first surgeon to be concerned with the "end result" of the procedures he was performing. Unfortunately for Dr. Codman, his "end result idea" was ahead of his time. His colleagues opposed his idea of following patients for a long time period to assess the efficacy of various procedures. Codman was forced to resign from his post at the Massachusetts General Hospital in 1914. However, his desire to measure the end result of his patients was not quelled. In 1918 he published a book entitled, "A Study in Hospital Efficiency: as demonstrated by the case report of the first five years of a private hospital." Eventually, Codman would go on to form his own private hospital where he continued to practice his end result idea. In 1973 John Wennberg published a method of population based epidemiologic analysis of the utilization of medical care in small areas. This kindled the development of small area analysis which has shown in the past 20 years the large variation in the use of medical care in geographic regions throughout the United States.