Patient-reported outcome measures, stored in the clinical record, help physicians optimize treatment.
Patients’ perceptions of whether a particular treatment improved their ability to function are gaining traction in health care decision-making.
The patient-reported outcome measures, or PROMs, tell an important story. How patients feel about their quality of life after care matters. For instance, can they climb stairs again? Take out the garbage? Walk around the neighborhood? Bring home groceries?
“Physician leadership should be looking for opportunities to introduce patient-reported data into clinical practice in every part of the clinical system,” says Mary Barton, MD, MPP, vice president of performance measurement at the National Committee for Quality Assurance.
Although patient surveys represent a step in that direction, anonymous responses offer little guidance in helping individuals. “Patient surveys are not optimal,” Barton says. “A better solution is for all patient-related data to be stored in the clinical record and reflected in the clinical encounter.”
In 2018, NCQA launched a $2.1 million demonstration dedicated to evaluating the use of PROMs over a three-year period. The Person-Driven Outcome Measurement project will explore how health care organizations or payers can implement PROMs to assess quality and establish best practices.
“We thought it was in great alignment with a number of our initiatives in serving the underserved,” says Patty Jones, RN, MBA, chief of health services at Community Health Plan of Washington, serving the state of Washington and one of four organizations selected by NCQA for the project among a pool of applicants.
“The purpose of this pilot is to develop methodologies or measure approaches to helping people participate in shaping the priorities in their health care,” Jones says, explaining that “the pilot is really looking to engage and empower members.”
For example, in a patient with diabetes and hypertension, the care team might focus on medication compliance, while the patient’s top priority could be to attend a child’s graduation or walk down the wedding aisle.
“How do you mesh those clinical goals with their personal goals?” she says, offering a tangible solution: “If they’re involved in the goal setting actively, they’re more likely to participate.”
The concept of PROMS is still evolving, but patients often relish the opportunity to relay their symptoms or function level, Barton says.
“PROMS are indeed not yet in widespread use,” she says. “They are new, and NCQA wants to help determine best workflows to minimize burden to the clinical team.”
Using PROMs is costly and time-consuming for both the physician’s office and the patient, says Henry B. Ellis Jr., MD, a pediatric orthopedic surgeon with the Texas Scottish Rite Hospital for Children in Frisco, north of Dallas.
“We oftentimes try to balance efficiency with customer service — who wants timely care and quality that can be followed and tracked through PROMs,” Ellis says.
For several years, he has been applying PROMs in clinical practice and research. The purpose is to gauge patients’ responses to treatment.
“It really helps us quantify the results of our treatment,” says Ellis, who provides orthopedic trauma and pediatric sports medicine coverage also at the University of Texas Southwestern Medical Center and nearby Children’s Medical Center Dallas. “And it will quantify their activity level following their treatment as well.”
Ellis relies on validated joint-specific PROMs, with questions pertaining to the functional activities that involve the injured body part. Patients younger than 12 complete the questionnaires with parents’ or guardians’ assistance.
PROMs are also useful in assessing adolescents’ coping skills with fear of reinjury. Young athletes who are afraid to resume playing sports may need modifications to post-operative rehabilitation or psychological counseling, and perhaps both, he says.
In addition to lending value to orthopedics, PROMs can guide care teams in managing virtually any ailment in which “the symptom is the outcome of relevance.” In respiratory conditions, for example, the major relevant symptoms are typically shortness of breath or cough, says Neil Wagle, MD, MBA, associate chief medical officer at Devoted Health, a new health insurer serving seniors based in Waltham, Massachusetts.
Wagle often employed PROMs in his previous position as associate chief quality officer at Partners Healthcare, the system affiliate of Harvard Medical School. In a nutshell, he describes PROMs as a “quantification of the outcomes that matter most to patients.” Their concerns center around outcomes such as whether they can walk more easily and have less pain after a specific procedure.
At the system level, PROMs can help identify services that are cost-effective while benefiting a large number of patients. “Health care is moving toward value,” Wagle says.
Susan Kreimer is a freelance health care journalist based in New York.