Think before you prep: Defining the terms of change in american healthcare

United States physicians are grappling with a fundamental reorganization of the healthcare system. Although many remain skeptical of governmental efforts at reform, they seem to take as given an industrial efficiency model of change, including large and integrated managed care arrangements and performance measurement based on outcomes such as quality. This uncharacteristic acquiescence seems to derive in part from a confounding of concepts. This article makes three distinctions: among knowledge about practice, knowledge about quality, and outcomes research; between outcomes research and the outcomes movement; and between the outcomes movement and other options for healthcare reform. The suggestion that statistical measurement of specific variables ought not to have a priori precedence over other ways of thinking—and doing something—about healthcare is made.