Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review

Boyce, M; Browne, John

doi:10.1007/s11136-013-0390-0

Cited by 177 publications

(165 citation statements)

References 38 publications

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“…Boyce and Browne's 24 systematic review examined PROMs feedback in the care of individual patients and at the aggregate level. They found only one study 25 examining the use of aggregate PROMs data, in which physicians were randomised either to receive peer comparison feedback on the functioning of older patients in their care or to be told that the functioning of their older patients would be monitored.…”

Section: Existing Evidencementioning

confidence: 99%

“…There are 16 reviews of the quantitative/randomised controlled trial (RCT) literature on the feedback of individual-level PROMs data 24,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] and one review currently in progress. 57 There is also one review of qualitative studies 58 and four mixed-method reviews.…”

Section: Existing Evidencementioning

confidence: 99%

“…48 There is some evidence to suggest that the purpose or function of PROMs feedback may influence its impact, with greater impact on patient outcomes when PROMs are used to monitor patient progress over time in specific disease populations, rather than as a screening tool. 24 One common pattern evident in these reviews is that PROMs feedback has a greater impact on clinician-patient communication, the provision of advice or counselling and the detection of problems than on patient management and subsequent patient outcomes. 48,49 This general conclusion is also mirrored in the reviews focusing on oncology.…”

Section: Introduction and Overviewmentioning

confidence: 99%

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Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

170

258

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Existing Evidencementioning

confidence: 99%

Section: Existing Evidencementioning

confidence: 99%

Section: Introduction and Overviewmentioning

confidence: 99%

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Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

170

258

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“…Handsearches yielded two further review articles (7,29). After iterative searching of reference lists, citation searches, and specific searches of articles from prominent researchers in the area, a total of 166 articles were obtained.…”

Section: Search Strategymentioning

confidence: 99%

Using Feedback From Patient-Reported Outcome Measures in Mental Health Services: A Scoping Study and Typology

Krägeloh¹,

Czuba²,

Billington³

et al. 2015

125

115

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Disclosures and AcknowledgementsThis study was funded by a contestable grant from the Faculty of Health and Environmental Sciences at Auckland University of Technology. Note that various terms are used to describe people receiving mental health services, including patients, clients, consumers, and service users (96). In order to be consistent with the established term PROM, we will occasionally refer to this group as patients, while acknowledging the sensitivity of this term, particularly to those who regard themselves as service users in recovery. Methods: Iterative scoping searches of the literature identified articles reporting on the use of PROM feedback in mental health settings, which were then categorized to develop a typology along a dimension of intensity of PROM feedback, ranging from no feedback to patient and clinician to clinician-patient discussion that followed a formalized structure. Results:Of the 172 studies that were identified, 27 were grouped into five categories, ranging from no PROMs feedback to either clinician or patient to studies in which a formalized structure was available by which PROM feedback could be discussed between clinician and patient. Of the 11 studies in the category with formalized feedback, nine studies reported some significant effects of feedback compared to a control condition, and two reported partial effects. Conclusions:The proposed procedural typology helps explain the diversity of results from studies reporting on the effects of PROM feedback, by highlighting that PROM feedback appears to be more effective when integrated in a formalized and structured manner. Future work is required to isolate these effects from common procedural correlates, such as monitoring of therapeutic alliance.2

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“…A recent review suggested that evidence indicating that feedback on patient-report outcomes to providers actually improves patient outcomes is mixed, but that feedback appears to be more effective when the data are used as part of a patient management system (Boyce and Browne, 2013). Currently, the ability to routinely monitor clinical outcomes for patients receiving PH care in the MHS is limited.…”

Section: Integrate Routine Outcome Monitoring For Service Members Witmentioning

confidence: 99%

Quality of Care for PTSD and Depression in the Military Health System: Phase I Report

Hepner¹,

Sloss²,

Roth³

et al. 2016

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This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.html.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. For more information on this publication, visit www.rand.org/t/RR978 Support RANDPublished by the RAND Corporation, Santa Monica, Calif. © Copyright 2016 RAND CorporationR® is a registered trademark. Cover: U.S. Air Force photo by Senior Airman Tabatha Zarrella iii PrefaceThe U.S. Department of Defense (DoD) strives to maintain a physically and psychologically healthy, mission-ready force, and the care provided by the Military Health System (MHS) is critical to meeting this goal. Given the rates of posttraumatic stress disorder (PTSD) and depression among U.S. service members, attention has been directed to ensuring the quality and availability of programs and services targeting these and other psychological health (PH) conditions. Understanding the current quality of care for PTSD and depression is an important step toward future efforts to improve care across the MHS.To help determine whether the service members with PTSD and/or depression are receiving evidence-based care and whether there are disparities in care quality by branch of service, geographic region, and service member characteristics (e.g., gender, age, pay grade, race/ethnicity, deployment history), DoD's Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to conduct a review of the administrative data and medical records of service members diagnosed with PTSD and/or depression and to recommend areas on which the MHS could focus its efforts to continuously improve the quality of care provided to all service members.This report should be of interest to MHS personnel who provide care for service members with PTSD and/or depression. It should also be useful to those responsible for monitoring the quality of that care and developing evidence-based quality measures to improve care for service members and individuals with PTSD or depression in other health systems.This research was sponsored by DCoE and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of ...

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Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review

Cited by 177 publications

References 38 publications

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Using Feedback From Patient-Reported Outcome Measures in Mental Health Services: A Scoping Study and Typology

Quality of Care for PTSD and Depression in the Military Health System: Phase I Report

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