Epidemiology and the health care revolution

PURPOSE: Revolutions in the health care marketplace, with their implied dependence upon the population perspective, have renewed interest in epidemiologic methods and their application. METHODS: As a way of organizing questions, data, and answers, epidemiology is once again the core scientific discipline for a multidimensional paradigm shift that emphasizes five facets of health care. First, the health of enrolled populations, rather than merely treatment of sick individuals presenting for care. Second, assessment of the “time, place, and person” of disease burden—who is healthy, who is not, and what it will take to maximize their health. Third, the causative factors for disease and the factors or characteristics that promote health. Fourth, the development of evidence-based clinical guidelines for clinicians and consumers alike. Fifth, evaluation of the impact providers are having on the health of populations (outcomes), individually and collectively. RESULTS: Thoughtful consideration of all of the above factors depends upon epidemiologic data and insights brought to a firm and conclusive end point capable of supporting policy. CONCLUSIONS: Credibility will require that epidemiologists (and the symbiotic media) exercise far greater restraint in drawing definitive conclusions and speculations from often startling but meager data.