The Use of Patient-Reported Outcome Measures in Clinical Practice and Clinical Decision Making

Abstract

Patient-reported outcome measures (PROMs) are highly effective measures of quality of care and outcomes that matter to patients regarding their physical, mental, and social health. While PROMs have played a notable role in research and registry reporting, they are also useful as clinical tools. Real-time PROM collection can be integrated into routine clinical care with immediate access to scores within the electronic health record. This can be integral when discussing treatment options and using decision aids. PROM scores can also be useful for postoperative monitoring. Various approaches to quantifying clinical efficacy have been developed, including the minimal clinically important difference, the substantial clinical benefit, and the patient acceptable symptom state (PASS). As the patient experience and patient-reported outcome measurement of health-related outcomes become increasingly emphasized in patientcentered, high value care, so too will the importance of methods to gauge clinical benefit using these instruments for improved clinical decision-making. The numerator of the "healthcare value equation" is focused on outcomes of care, as experienced by the patient. Healthcare qualityespecially in orthopaedics-centered on codes that readily extract outcomes data from administrative databases. These metrics include readmission rates, surgical complications, length of stay, discharge to skilled nursing facilities, and mortality rates to name a few. While valid, easy to access, and reasonable to measure, these metrics are not truly patientcentered. In the context of major joint arthroplasty, examples of patientcentric quality metrics would include improvement in function or a decrease in pain. Such outcomes may be captured subjectively in clinician documentation after surgery and are typically qualitative, subjective, and nearly impossible to aggregate into meaningful applications.High-quality forms of measurement which allow clinicians to measure the effect of health care through the lens of the patient experience are patient-

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“…28 With research and health policy placing increasing value on the patient experience, there is a push toward integrating PROMs into routine clinical care. 30 Doing so, however, requires that physicians have a comprehensive understanding of normative values, reference ranges, and predictive thresholds.…”

Development and Validation of a Canine Health-Related Quality of Life Questionnaire and a Human–Canine Bond Questionnaire for Use in Veterinary Practice

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