The focus on quality and accountability in healthcare has dramatically changed the manner in which clinical services are delivered. The traditional reliance on structural aspects of healthcare delivery has largely given way to a system that closely monitors processes and measures outcomes. Outcomes measurement has intuitive appeal because of its objectivity, global perspective on healthcare, and input from patients, providers, insurers, and payers in the healthcare delivery chain. Nevertheless, outcomes measures are destined to be closely linked to healthcare processes. Data from clinical investigations, interpreted using rigorously developed, evidence-based methodologies, must be used to provide feedback to those designing clinical processes and to continuously improve the quality of healthcare. As outcomes data will be crucial in evaluating the quality of services provided by managed care organizations in relation to their costs, it is imperative that osteopathic physicians become conversant with the history and evolution of outcomes measurement and management.