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Research Methods & Reporting

Prognosis research strategy (PROGRESS) 1: A framework for researching clinical outcomes

BMJ 2013; 346 doi: (Published 05 February 2013) Cite this as: BMJ 2013;346:e5595
  1. Harry Hemingway, professor of clinical epidemiology1,
  2. Peter Croft, professor of epidemiology2,
  3. Pablo Perel, clinical senior lecturer3,
  4. Jill A Hayden, assistant professor4,
  5. Keith Abrams, professor of medical statistics5,
  6. Adam Timmis, professor of clinical cardiology6,
  7. Andrew Briggs, Lindsay chair in health policy & economic evaluation7,
  8. Ruzan Udumyan, research assistant1,
  9. Karel G M Moons, professor of clinical epidemiology8,
  10. Ewout W Steyerberg, professor of medical decision making9,
  11. Ian Roberts, professor of epidemiology and public health3,
  12. Sara Schroter, senior researcher10,
  13. Douglas G Altman, professor of statistics in medicine11,
  14. Richard D Riley, senior lecturer in medical statistics12
  15. for the PROGRESS Group
  1. 1Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
  2. 2Arthritis Research UK Primary Care Centre, Keele University, Keele ST5 5BG, UK
  3. 3London School of Hygiene & Tropical Medicine, London WC1E 7HT
  4. 4Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7
  5. 5Centre for Biostatistics & Genetic Epidemiology, Department of Health Sciences, School of Medicine, University of Leicester, Leicester LE1 7RH, UK
  6. 6London Chest Hospital, London E2 9JX
  7. 7Health Economics & Health Technology Assessment, Centre for Population & Health Sciences, University of Glasgow, Glasgow G12 8RZ, UK
  8. 8Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
  9. 9Department of Public Health, Erasmus MC, Rotterdam, Netherlands
  10. 10BMJ, BMA House, London WC1H 9JR
  11. 11Centre for Statistics in Medicine, University of Oxford, Oxford OX2 6UD, UK
  12. 12School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK
  1. Correspondence to: H Hemingway h.hemingway{at}
  • Accepted 29 July 2012

Understanding and improving the prognosis of a disease or health condition is a priority in clinical research and practice. In this article, the authors introduce a framework of four interrelated themes in prognosis research, describe the importance of the first of these themes (understanding future outcomes in relation to current diagnostic and treatment practices), and introduce recommendations for the field of prognosis research

In clinical medicine, the term prognosis refers to the risk of future health outcomes in people with a given disease or health condition. Prognosis research is thus the investigation of the relations between future outcomes (endpoints) among people with a given baseline health state (startpoint) in order to improve health (see supplementary figure on The study of prognosis has never been more important, as globally more people are living with one or more disease or health impairing condition than at any previous time.1 For this reason, governments across the world are increasing their interest in the outcomes of healthcare currently provided for people with disease.2 Similarly, research funders and researchers are increasingly focused on translating new interventions and technologies from the laboratory to clinical practice and then healthcare policy in order to establish and implement new standards of high quality care and improve patient outcomes.

Prognosis research findings should thus be integral to clinical decision making, healthcare policy, and discovering and evaluating new approaches to patient management. However, there is a concerning gap between the potential and actual impact of prognosis research on health. Prognosis research studies too often fall a long way short of the high standards required in other fields, such as therapeutic trials and genetic epidemiology.

In the PROGnosis RESearch Strategy (PROGRESS) series (, we propose a framework of four distinct but inter-related prognosis research themes:

  • (1) The course of health …

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