Introduction

The progression of a disease state can be characterised in terms of input, process and output. Medical audit seeks to compare actual and ideal outcome by examining the management of the patient, taking into account the severity of the disease and the general health of the patient. Was it appropriate to the presenting complaint? Did it make the most effective use of existing resources? Did it offer the best value for money in terms of that particular disease and also in relation to other demands on the health service? These questions cannot be addressed in any scientific manner unless there are objective measurements for the severity of the presenting condition, the type of treatment and the outcome. This chapter examines ways of measuring outcome and the limitations of their use in clinical audit. In an ageing population chronic diseases are becoming more prevalent and cure is unusual. Outcome is often a balance between the activity of the disease process and the effectiveness of treatment. Much of the discussion will therefore overlap into the measurement of disease severity, investigation and treatment.

Gordon has contrasted the significant improvement in weather forecasting over the recent years with our more modest achievements in medicine.