The history of using health-care outcome instruments in the United States dates back to the early 1900s. Earnest Codman, a Boston area surgeon in the early part of the 20th century, was the first to pioneer the use of patient outcomes [1]. Dr Codman was a staunch advocate for the systemic evaluation of surgical outcomes. He established the first morbidity and mortality conference at the Massachusetts General Hospital (MGH), instituted the first system to track long-term patient outcomes, and promoted a mechanism for formally evaluating surgeon competence based on quantifiable outcomes.
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