Integrating the Use of Patient‐Reported Outcomes for Both Clinical Practice and Performance Measurement: Views of Experts from 3 Countries

Wees, Philip J. van der; Sanden, Maria W. G. Nijhuis-van der; Ayanian, John Z.; Black, Nick; Westert, Gert P.; Schneider, Eric C.

doi:10.1111/1468-0009.12091

Cited by 194 publications

(191 citation statements)

References 30 publications

(59 reference statements)

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“…269 The collection and feedback of PROMs in the care of individual patients has not formed an explicit part of government policy in the UK. For example, it was never intended that data collected as part of the English national PROMs programme would be routinely fed back at an individual level to clinicians to inform their care of individual patients, although it is possible for clinicians to request data for specific patients.…”

Section: Candidate Programme Theories Underlying Patient-reported Outmentioning

confidence: 99%

“…16 Van der Wees 269 identified three models of PROMs data collection internationally and we have provided examples of each model below:…”

Section: Actionabilitymentioning

confidence: 99%

“…The first is whether or not it is possible to achieve the necessary trust between different stakeholders such that the collection of PROMs feedback is perceived as being focused on improving the quality of patient care. 269 The second is whether or not the same PROM can be used for multiple purposes, as PROMs that clinicians find useful in assessment of patients, such as individualised measures, are not useful as indicators of service quality. 16 We would argue that these two questions remain a challenge and should be the focus of future research.…”

Section: Actionabilitymentioning

confidence: 99%

“…16,269 For example, Wolpert 16 noted that PROMs data are often mandated for routine collection as measures of service quality without considering how such measures can be integrated with 'clinical conversations or clinical care'. She argued that the value of using PROMs data for audit purposes is often disconnected from the challenges faced by those tasked with implementing the measures on the ground, where they may undermine the clinical encounter.…”

mentioning

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

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173

263

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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: Candidate Programme Theories Underlying Patient-reported Outmentioning

confidence: 99%

“…16 Van der Wees 269 identified three models of PROMs data collection internationally and we have provided examples of each model below:…”

Section: Actionabilitymentioning

confidence: 99%

Section: Actionabilitymentioning

confidence: 99%

mentioning

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

Self Cite

173

263

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“…[1][2][3][4][5][6][7] Because PROs capture domains that cross conditions and reflect patient-centered priorities, such measures may more accurately reflect the health and well-being of individuals with multiple chronic medical conditions (MCCs) than do common disease-specific quality measures. 8,9 Across populations, higher scores on these and other domains of health-related quality of life (HRQOL) correlate with lower rates of hospitalization, lower overall mortality, lower cardiovascular morbidity, and lower outpatient services utilization in populations of patients with chronic illness.…”

mentioning

confidence: 99%

Association between Continuity of Care and Health-Related Quality of Life

et al. 2017

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Background: Patient-reported outcomes (PROs) are considered potential quality metrics for patients with multiple chronic medical conditions (MCC). Although continuity of care (COC) is an essential MCC care process, the association between common PROs and COC is unknown.Methods: We assessed baseline and two-year follow-up self-reported health status, physical, and emotional well-being, and COC in seniors with MCC. Using mixed effects models with repeated measures adjusting for age, gender, and morbidity, we assessed each outcome as a function of COC.Results

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Patient-Reported Outcome Measures Within a National Multispecialty Surgical Quality Improvement Program

Temple,

Pusic,

Liu

et al. 2024

JAMA Surg

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ImportancePatient-reported outcome measures (PROMs) are increasingly recognized for their ability to promote patient-centered care, but concerted health information technology (HIT)–enabled PROM implementations have yet to be achieved for national surgical quality improvement.ObjectiveTo evaluate the feasibility of collecting PROMs within a national surgical quality improvement program.Design, Setting, and ParticipantsThis was a pragmatic implementation cohort study conducted from February 2020 to March 2023. Hospitals in the US participating in the American College of Surgeons National Surgical Quality Improvement Program and their patients were included in this analysis.ExposuresStrategies to increase PROM collection rates were identified using the Institute for Healthcare Improvement (IHI) Framework for Spread and the Consolidated Framework for Implementation Research and operationalized with the IHI Model for Improvement’s Plan-Do-Study-Act (PDSA) cycles.Main Outcomes and MeasuresThe primary goal was to accrue more than 30 hospitals and achieve collection rates of 30% or greater in the first 3 years. Logistic regression was used to identify hospital-level factors associated with achieving collection rates of 30% or greater and to identify patient-level factors associated with response to PROMs.ResultsAt project close, 65 hospitals administered PROMs to 130 365 patients (median [IQR] age, 60.1 [46.2-70.0] years; 77 369 female [59.4%]). Fifteen PDSA cycles were conducted to facilitate implementation, primarily targeting the Consolidated Framework for Implementation Research domains of Inner Setting (ie, HIT platform) and Individuals (ie, patients). The target collection rate was exceeded in quarter 3 (2022). Fifty-eight hospitals (89.2%) achieved collection rates of 30% or greater, and 9 (13.8%) achieved collection rates of 50% or greater. The median (IQR) maximum hospital-level collection rate was 40.7% (34.6%-46.7%). The greatest increases in collection rates occurred when both email and short-message service text messaging were used, communications to patients were personalized with their surgeon’s and hospital’s information, and the number of reminders increased from 2 to 5. No identifiable hospital characteristic was associated with achieving the target collection rate. Patient age and insurance status contributed to nonresponse.Conclusions and RelevanceResults of this cohort study suggest that the large-scale electronic collection of PROMs into a national multispecialty surgical registry was feasible. Findings suggest that HIT platform functionality and earning patient trust were the keys to success; although, iterative opportunities to increase collection rates and address nonresponse remain. Future work to drive continuous surgical quality improvement with PROMs are ongoing.

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Integrating the Use of Patient‐Reported Outcomes for Both Clinical Practice and Performance Measurement: Views of Experts from 3 Countries

Cited by 194 publications

References 30 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

Association between Continuity of Care and Health-Related Quality of Life

Patient-Reported Outcome Measures Within a National Multispecialty Surgical Quality Improvement Program

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