- Healthcare professionals are increasingly noting the value of patient-reported outcomes measures (PROMs) to supporting patient-centered healthcare. But when it comes to PROMs challenges abound, keeping some organizations from fully integrating these measures into their patient engagement strategies.
PROMs are a collection of surveys or measures that assess how a patient feels following a healthcare encounter. PROMs don’t necessarily look at the clinical outcomes of a procedure (such as hospital readmissions), but instead assess how the patient feels following a healthcare encounter. PROMs measure the outcome or a care encounter, not the process.
A typical PROM will ask about a patient’s mobility after a knee surgery, or if she feels well enough to carry her own groceries inside after being treated for a heart condition, for example.
PROMs are also distinct from patient satisfaction scores, such as HCAHPS. HCAHPS surveys assess elements of the patient-provider interaction and facility satisfaction. A patient can report a negative experience with hospital staff while still reporting positive PROMs.
Currently, very few medical professionals are leveraging PROs consistently, according to a 2016 Health Catalyst survey. About one-fifth of hospitals routinely use PROMs to understand patient care outcomes.
Seventy-three percent of survey respondents said they planned on integrating PROs into their data collection strategies within the coming two to three years as industry leaders increasingly recognize the value PROs can bring to healthcare.
But healthcare professionals currently face a set of challenges keeping them from successfully integrating PROMs into their patient-centered strategies. Between understanding which PROMs to collect and the technology necessary to obtain that data, organizations face an uphill battle.
Methodology and data collection barriers
Before a healthcare organization can begin collecting PROMs, it must decide which measures it wants to assess. There is no standard PROM requirement, meaning organizations have the flexibility to analyze the elements that are most appropriate for specific patient populations. With this flexibility comes a considerable amount of decision-making.
There are numerous models available for organizations to adopt for their PROMs efforts. The National Quality Forum (NQF) has developed PROMIS, the Patient Reported Outcome Measurement Information Systems. There are other measure sets catered to specific conditions or patient populations, such as Neuro-QoL, NIH Toolbox, and ASCQ-Me.
Organizations can assess those measure sets to determine which might be most appropriate for their specific needs.
Medical professionals also face barriers when extending these surveys to their patient populations, highlighting a set of measure collecting issues, according to NQF.
“While there has been great interest in using PROs, foundational work needs to be done to address methodologic and data challenges,” NQF wrote on its website. “Efforts are currently underway to develop and test mechanisms for collecting patient-reported data.”
Healthcare professionals must determine how best to administer PROM surveys to patients and collect patient answers without becoming too burdensome, according to Neil W. Wagle, MD, MBA. Wagle authored a case study about PROM use at his hospital, Brigham and Women’s Hospital in Boston.
“As PROMs collection becomes more widespread, we’ll need strategies to avoid overwhelming patients with constant surveys and to reach them conveniently without jeopardizing privacy,” Wagle stated.
Healthcare organizations should not ask patients too many questions on PROM surveys. A patient may not complete a 50-question survey, but a survey with between 20 and 30 questions may be palatable.
Additionally, organizations should use lay language and put outcomes measures in context that is familiar to patients. Survey questions should ask patients if they can walk a few blocks, for example, or ask a child if he feels well enough to play with his friends at recess.
Using technology to collect PROMs poses obstacles
Healthcare technology also poses a challenge for organizations considering using PROMs, with 15 percent of respondents reporting such in the Health Catalyst survey.
According to Wagle, ensuring PROMs data will work well with a hospital’s technology is essential because otherwise the data has little utility.
PROM data would ideally be electronic, and that requires interoperability with EHRs. Collecting PROMs also takes more time out of the clinical encounter, Wagle added, and presents a challenge for physicians.
“If PROMs are to be used eventually as a quality measure for reimbursement programs, we must determine how to risk-adjust for clinical and sociodemographic patient characteristics,” Wagle wrote. “Data interoperability will also be essential.”
Healthcare organizations must consider several factors when selecting a technology to support PROMs collection. For one, they must ensure they are using a tool that collects the relevant PROMs (PROMIS versus Neuro-QoL, for example). They should also use tools that offer the survey in multiple languages.
As Wagle noted, it is useful to have a tool that is interoperable with the organization’s EHR. This allows clinicians to leverage that data in near real-time and make appropriate care adjustments from there.
Organizations should not necessarily rely on the patient portal to collect PROMs. Although the highly patient-centric tool may sound ideal for engaging patients in the survey, there is in fact limited patient portal uptake. Research has shown that most patients have access to patient portal accounts, but actionable portal use is still low.
Other technologies, such as office-based kiosks and tablets in the waiting room or at the bedside, could serve as valuable options for collecting PROs. These tools reach patients who might not be engaged enough to answer survey questions at home, or who do not own a personal device to access the patient portal.
As healthcare becomes more patient-centric, it will be important for clinicians to look at not only the clinical results of care, but how that care impact the patient’s quality of life. PROMs offer a viable opportunity for assessing those types of care outcomes.
However, understanding which PROMs will be most useful for a specific patient population and leveraging the right technology for PROM collection will be essential.