Table 4. Outcome-Type Taxonomy.

Outcome	Definition	Examples
Pure Outcome1	A change in health status intrinsic to the patient, where the health status attribute used to assess or measure the outcome is (one of) the primary focal points of the care provided, should be monitored as a routine matter of providing care (to prevent or avoid comorbidities or complications), or is a necessary condition for achieving the purpose of the care.	Change in ability to ambulate between start of care and discharge for a home health patient admitted with an orthopedic condition. Change in status of a pressure ulcer over a 4-week period for an immobile nursing home resident receiving repositioning, debridement, and nutritional services. Change in ability to articulate specific words over a 3-month episode of care for a head injury patient who received speech/language pathology services at home since shortly after the head trauma.
Instrumental Outcome1	A change intrinsic to the patient (or the patient's informal caregiver) in knowledge, emotion, or behavior that is or may be instrumental to attaining a pure outcome. Care can be provided for the purpose of enhancing instrumental outcomes which, in turn, facilitate attaining pure outcomes.	Change/improvement in a home care patient's awareness of early signs of infection at a wound site. Extent of a cardiac patient's compliance with a prescribed exercise and nutritional program. Change in patient knowledge of how to conduct a self-examination for a particular type of tumor.
Utilization Outcome	An event that reflects or is a proxy for a pure outcome, often in the form of utilization of health services other than those provided in the care setting or by the individual provider whose outcomes are being assessed.	Hospital admission (for acute malnutrition) of an elderly nursing home patient receiving dietary and nutritional services in the nursing home. Nursing home admission for a moderately cognitively impaired patient receiving home care, who is on several medications simultaneously. Emergent care due to infection at a wound site for a postsurgical patient receiving wound care from a home health provider.

¹Pure and instrumental outcomes have been respectively termed “end-result” and “intermediate-result” outcomes in some of our prior writings.

SOURCE: Shaughnessy, P.W., Kramer, A.M., Hittle, D.F., and Steiner, J.F., University of Colorado Health Sciences Center, 1995.