Analysis of the NEJM Catalyst Insights Council Survey on Patient-Reported Outcome Measures. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.
Improving clinical outcomes and enhancing patient experience are closely related health care objectives. However, while clinical outcomes lend themselves to measurement, quantifying how an individual patient experiences symptoms or a loss of function can be more challenging.
One promising approach is the use of Patient-Reported Outcome Measures (PROMs). PROMs use patient questionnaires to turn symptoms and patient function losses into numerical scores, similar to the way that traditional patient experience surveys work. And once these aspects are converted into numerical values, a range of comparative analysis becomes possible.
Currently, PROMs use is fairly modest, although this is changing. According to a survey of NEJM Catalyst Insights Council members in June 2019, 38% currently use a PROMs system at their organization and 17% plan on doing so within the next 3 years. This means that more than half (55%) will be using such a system in 3 years. Respondents say the top two reasons health care organizations collect and use PROMs are to improve patient experience (60%) and improve quality metrics (52%).
Judy Baumhauer, MD, MPH, is Professor and Associate Chair of Orthopedic Surgery at the University of Rochester Medical Center, and also serves as Director of the Clinical BioInformatics Core coordinating and collecting patient-reported outcomes, specifically PROMIS, for the UR Medicine health care system. The University of Rochester Medical Center began using PROMIS approximately 4 years ago, starting with orthopedics.
“Right now, it’s used in approximately 60–65% of our health care system clinics and surgical suites and it’s continuing to spread,” she says.
Rather than using a top-down approach to drive clinician use of PROMIS, the organization went with a more open approach. “Clinicians were offered the opportunity to collect PROMIS assessments in their clinics and instantaneously view the results in the electronic record to help quantify how their patients were functioning and feeling,” says Baumhauer. “We did it from bottom up, using more of a grassroots approach. And so those who wanted it were brought on board and those who didn’t, we didn’t mandate that they begin collecting data.”
“But just by diffusion, if you will, various groups realized that it was insightful and there was informal discussion between users and nonusers, which would ultimately lead to them joining the program,” Baumhauer says. “As an example, certain divisions within our cancer group wanted to use PROMIS. So we gave them the opportunity to collect the data and now the entire cancer group wants it, and we’ll be rolling that out next month. So it’s interesting how diffusion occurs.”
Implementing a PROMs system can be a complex undertaking, requiring the integration of the PROMS data with existing EHR applications so that data flows to providers in real time. Given that it may also add to clinician and clinical staff workloads, it is fair to ask whether PROMS are worth the effort.
Nearly half of survey respondents (49%) say that PROMs are worth the effort involved in collecting, processing, and implementing them, and only a small number (13%) report that they are not worth it. A fairly large number (38%) say that they don’t know, but this may be because their organization is in the early stages of integrating a PROMs system.
According to Baumhauer, the PROMIS initiative has been well worth the effort, although implementation was not without some challenges. “There are always growing pains with any new initiative,” she says. “We continue to focus on physician education and making the information more meaningful in a clinical setting. The key is for the information to be both actionable and meaningful, with the end result being to decrease variation and improve patient care.”
Download the full report to see the survey methodology and more.
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