In a recent blog, we called for a shift in the way we measure quality in healthcare post COVID-19. Measurement of patient reported outcomes has long been regarded as a worthy substitute for most, if not all the quality measures that providers are required to report on.
Patient reported outcome measures (PROMs) seek to ascertain patients’ views of their symptoms, their functional status, and their health-related quality of life1. PROMs were started as research tools, but they have recently been used to assess and compare the outcomes achieved by different interventions and healthcare providers.
An example of one such tool is the Common Fund’s Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS includes measures such as pain, fatigue, physical functioning, emotional distress, and social role participation that have a major impact on quality-of-life across a variety of chronic diseases2. PROMIS measures were developed for children and adults and were validated for use in cancer, congestive heart failure, depression, arthritis, and multiple sclerosis, as well as chronic pain conditions.
The University of Rochester collects scores from 80% of patients on three PROMIS domains — physical function, pain interference, and depression — through in-clinic testing that requires an average of 2.4 minutes to complete (patients are handed an iPad when they check in and complete the questionnaire while waiting). In two years, 148,000 unique patients completed over 1.1 million PROMIS assessments3. By analyzing this vast database, University of Rochester physicians were able to assess the impact of commonly performed surgeries on physical function, pain, and depression over the course of an episode of care. For example, by looking at aggregate PROMIS data on a specific surgical procedure for chronic ankle sprains, which was performed for years, orthopedic surgeons at the University of Rochester discovered that the most expensive variation of the procedure, was also the least effective. Discovering that patients reported poorer outcomes with this procedure drove surgeons to choose a different method for future cases4.
PROMs provide comparison between physicians, the preferred approach to treatment of a wide array of clinical conditions and importantly, offer patients understandable and clear information about the experience of other patients with similar conditions.
Measurement of PROMs is not without challenges. Several biases might significantly impact the answers provided by patients on these outcome questionnaires. The non-response bias results from the non-random decision of some patients to decline participation, thus skewing the results. The appeasement bias is the extent to which patients provide responses according to what they believe their doctors would want to hear5.
In spite of these challenges, it is clear that measurement of patient reported outcomes shows great promise as we explore ways to measure the true value of the care rendered to our patients.