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  1. Ditmyer, Sue MSN, RN
  2. Koepsell, Barbara MPH, RNC
  3. Branum, Vicky MSN, RN
  4. Davis, Pat MS, RN
  5. Lush, Mary T. PhD, RN


In an era of rapidly shifting resources and changing models of care, healthcare providers must demonstrate quality and cost-effective patient care. Historically, quality of care has been described using administrative variables such as mortality, morbidity, length of stay, readmissions, and cost. Methods have not been readily available to define quality in terms of the effect of care delivery on the health of patients. Combined administrative and health-related databases are foundational to outcome infrastructures evolving with the electronic medical record. Nursing leaders in a large health maintenance organization sponsored the development of the Health Status Outcome Dimensions (HSOD) instrument. The HSOD instrument includes measures of functional status, knowledge, and engagement in healthcare and the patient and family psychosocial well-being. This article describes the processes used and the challenges faced in the development of the HSOD instrument. The current status of the HSOD instrument is described, as well as its planned future development.