Monitoring and Analysis of Outcome Studies

Monitoring technology appears to be advancing at a rate that exceeds our ability to assess its effectiveness. RCTs are often poorly designed and lack statistical power. Even high-quality RCTs might not provide inferences that can be generalized across all patient populations. Alternative methods of technology assessment such as closed claims analysis, metaanalysis, and statistical process control also have limitations. PORTs using a standard model of combined techniques are beginning to solve some of the more common methodologic problems. The future of technology assessment relies on the ability to conduct large-scale cohort studies from routine practice settings. In terms of intraoperative monitors, this could require production of a complete and valid database of all monitored variables that can be compared with a complete and valid database of appropriate outcome indicators. National standards for collection of data need to be developed. At this time, professional societies should focus more on developing guidelines for technology assessment than guidelines for technology utilization.