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Patient-Reported Outcomes Inadequate Clinical Quality Measures

Improving care quality had little effect on patient-reported outcomes, showing that PROs are an inadequate clinical quality measure.

Patient-reported outcomes are an inadequate clinical quality measure.

Source: Thinkstock

By Sara Heath

- Patient-reported outcomes (PROs) are not an accurate clinical quality measure, although they are valuable for promoting patient-centered care, according to research out of Kaiser Permanente’s Institute of Research.

The study, published in the Journal of the American Board of Family Medicine, investigates whether patient-reported quality of life can accurately measure various aspects of clinical quality in chronic care management.

The research team administered two surveys to 806 patients over the age of 65 managing at least three chronic medical conditions. The surveys measured three components of quality of life, including self-reported health status, physical function, and emotional well-being. The team administered one survey at baseline and another two years later.

The team measured quality of life against continuity of care (COC) scores. COC is an integral aspect of chronic care management because patients need seamless treatment from various primary care doctors and specialists to adequately balance different comorbidities.

The team measured COC using the COC Index (COCI), which measures the concentration of visits to individual providers. Patients must visit at least three clinicians annually to yield a strong COCI score.

The study results showed little difference in both COC and patient-reported quality of life over the two-year test period. Baseline continuity of care, scored on a scale of 0-1, was .24. During follow-up, continuity of care was .22.

Quality of life was scored on a 0-100-point scale. At baseline, self-reported health status was 48.7, physical function was 36.4, and emotional well-being was 54.8. Follow-up showed only marginal increases, with health status jumping to 59.6, physical function to 36.5, and emotional well-being to 59.6.

The low association between patient-reported quality of life and continuity of care scores shows that PROs are not an adequate measure of clinical quality, the researchers determined.

“Based on this analysis, self-reported health status and physical and emotional well-being do not seem to be associated with COC,” the researchers found. “This suggests that these well-validated and easily quantifiable PROs may not accurately reflect the important processes of care for [multiple chronic conditions] and should be used with caution as a broad quality measure for this population.”

PROs do not meet certain criteria set for measuring quality measures, specifically being valid and responsive to the care process or intervention, the researchers pointed out. In this case, the care process or intervention was continuity of care.

PROs may not be an accurate clinical quality measure because PROs incorporate a number of different factors, the researchers posited.

“[Health-related quality of life] is a broad construct that reflects biological factors, functional status, social and emotional well-being, environmental influences, expectations of health, and disease-specific symptoms,” the researchers explained.

“As a care process, COC is only one aspect of patient-centered care that may affect health outcomes, and even optimal chronic disease care may not markedly affect overall morbidity burden — especially in the short term,” the continued.

Despite these findings, the researchers maintained that PROs are important to patient-centered care.

“Systematically assessing patient-reported information as part of an annual health assessment can guide patient-centered care and shared decision-making,” they wrote. “When PROs have been systematically integrated into care delivery, patients find the ensuing discussions helpful and patient-centered.”

Patients consistently describe high-quality care as empathetic, respectful, thorough, continuous, efficient, safe, and of high technical quality. PROs usually represent a combination of some or all of these characteristics, helping to inform patient-centered care.

While tackling patient-centered care initiatives can be important, the researchers concluded that it will not necessarily result in a firm grasp on clinical quality. Thus, clinicians must look at both traditional clinical quality measures and PROs for a well-rounded picture of practice improvement.

“Although systematic assessment of PROs can and should inform optimal care, assessing and acting on PROs may be more reflective of high-quality care for multiple chronic conditions than the specific scores themselves, which may not reflect important care processes such as high COC,” the team concluded.

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