PROMs data: can it be used to make decisions for individual patients? A narrative review (original) (raw)
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From the standpoint of the healthcare provider, multiple contributors to a patients’ clinical presentation, difficulty with translating research trials into one’s practice, conflicting clinical practice guidelines, and an ever increasing volume of literature compounds the difficulty for clinicians to determine best care, which addresses the biological, psychological and sociological health domains. If clinicians are adopting a patient centred model of care –routine use of validated patient reported outcome measures (PROMs) which elicit patients’ views of their symptoms, their functional status, their health-related quality of life (HRQoL), all of which encompass several domains – are paramount. This commentary advocates for the use of PROMs on a wider scale than is currently described in the literature. Background information on PROMs is provided along with suggesting important questions to ask as a clinician when implementing these in practice. The current commentary addresses these questions and describes the implementation of PROMs using published case studies that describe osteopathy management for a variety of conditions.
Patient-reported outcome measures: an overview
British journal of community nursing, 2011
With the increasing prominence of the patients' involvement in the care they receive, the assessment of outcomes based on the patient's perspective using patient-reported outcome measures (PROMs), are increasingly accompanying the traditional clinical ways of measuring health and the effects of treatment on the patient. This article provides an overview as to what PROMs are and the different health constructs they are purported to measure. Differences between generic and disease-specific, multidimensional and index scored PROMs are also described. Factors relating to the choice of a PROM are discussed with a particular focus on the importance of developing a measurement strategy and endpoint model to ensure the appropriate PROM is selected to measure the desired outcome. Examples of the application of PROMs are given together with some of the methodological approaches to interpreting PROM data. Finally, issues on maximizing the benefits of using PROMs are briefly discussed.
2019
BackgroundPatient reported outcomes (PROs) provide information on a patient’s health status coming directly from the patient. Measuring PROs with patient reported outcome measures (PROMs) has gained wide interest in clinical practice for individual patient care, as well as in quality improvement, and for providing transparency of outcomes to stakeholders through public reporting. However, current knowledge of selecting and implementing PROMs for these purposes is scattered, and not readily available for clinicians and quality managers in healthcare organizations. The objective of this study is to develop a framework with tools to support the systematic selection, implementation and evaluation of PROs and PROMs in individual patient care, for quality improvement and public reporting.MethodsWe developed the framework in a national project in the Netherlands following a user-centered design. The development process of the framework contained five iterative components: (a) identificatio...
Monitoring of patients' physical and psychological problems during and after cancer treatment is essential in modern oncology practice. Traditional clinical methods can be supplemented by Patient-Reported Outcomes Measures (PROMs) measures. The potential role of PROMs is recognised and endorsed by national and international practice guidelines. The introduction of formal measurement of PROMs in clinical practice is a complex health care innovation requiring careful planning, design and successful implementation of a number of essential components, such as choosing the patient questionnaire(s), a convenient affordable electronic method for reporting and display in hospital records and engaging clinicians to use and act on the reports. There is mounting research evidence that using PROMs in individual patient care in oncology is beneficial to patients, but this approach has not found a place in routine clinical practice. A brief overview of this evidence will be provided. Following this, the presentation will focus on examples of incorporating PROMs and eHealth interventions into routine patient care during and after cancer treatment, drawing on 20 years' experience in Leeds of using electronic systems for capturing patient reported data in oncology settings. Examples will be given of: 1) Monitoring toxicity during systemic cancer treatment using online PROMs integrated with Electronic Patient Records (randomized trial part of NIHR eRAPID programme); 2) Service development project-Remote follow-up of testicular cancer patients using online PROMs plus community-based investigations. Examples of other online PROMs systems will be presented. The values and challenges of PROMs integration in routine oncology practice will be discussed.
The Use of Patient-reported Outcomes at an Individual Level – Benefits and Challenges
European Oncology & Haematology, 2010
The aim of this article is to review the application of patient-reported outcomes (PROs) in clinical care and consider its benefits, challenges and potential improvements. Previous studies demonstrated that health-related quality of life (HRQoL) data provide information to clinicians on patient health status, QoL, symptoms and wellbeing, along with any changes in these, and helps clinicians judge the needs of patients and tailor treatments accordingly. In addition, the benefits of the application of HRQoL tools include the involvement of patients in informed decision-making in terms of their treatment or care, higher patient satisfaction with healthcare services, improved patient–clinician relationships and better communication. In many studies, health professionals have expressed their interest in using these measures but feel they need to better understand them. Despite the wide use of information-gathering questionnaires and their promising results, it is still a challenge to predict the full value of these measures in clinical care. This article addresses these major concerns.
Understanding patient reported outcome measures (PROMs)
2011
AbstRAct Patient-reported outcome measures (PROMs) have been identified as being measures of a patient's health status or health-related quality of life, allowing for health status information to be collected from patients before and after an intervention through completion of a questionnaire. The information collected will provide an indication of the outcomes or quality of care delivered to NHS Patients.
Background: The 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. Objectives: To (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. Design: Two 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. Interventions: Aggregate – 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 measures: Aggregate – 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 sources: Searches of electronic databases and forwards and backwards citation tracking. Review methods: Realist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care. Results: Providers 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 limitations: There 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. Conclusions: PROMs 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 work: Future 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 registration: This study is registered as PROSPERO CRD42013005938. Funding: The National Institute for Health Research Health Services and Delivery Research programme
Nephrology, 2020
Patient-reported outcome measures (PROMs) are increasingly being used in nephrology care. However, in contrast to well-known clinical measures such as blood pressure, health-care professionals are less familiar with PROMs and the interpretation of PROM scores is therefore perceived as challenging. In this paper, we provide insight into the interpretation of PROM scores by introducing the different types and characteristics of PROMs, and the most relevant concepts for the interpretation of PROM scores. Concepts such as minimal detectable change, minimal important change and response shift are explained and illustrated with examples from nephrology care. K E Y W O R D S data interpretations, minimal clinically important difference, patient-reported outcome measures, psychometrics, quality of life Over the last decades, a shift towards a more value-based and patientcentred health care has taken place, resulting in a stronger focus on patient-reported outcomes (PROs) such as health-related quality of life (HRQOL) and symptom burden. 1,2 PRO measures (PROMs) are nowadays introduced in nephrology care and may be used at individual level for personalized care and at aggregated level to evaluate health-care quality. The use of PROMs at individual level as part of personalized care has been considered of great added value, as it may provide insight into patients' perceived health and their needs, and enhance patient-professional communication and shared decision making. 3,4 Ultimately, PROMs can be used to improve symptom management, HRQOL and other outcomes of health care. 5,6 To achieve such goals, knowledge about PROMs and the interpretation of PROM scores are needed. In contrast to well-known clinical outcomes such as blood pressure, health-care professionals and researchers are not yet familiar with PROMs and the interpretation of PROM scores is therefore perceived as challenging. For example: What does a symptom burden score of 27 mean? Is an HRQOL-score of 36 normal for a certain patient or in a
Impact of patient-reported outcome measures on routine practice: a structured review
Journal of Evaluation in Clinical Practice, 2006
Rationale, aims and objectives Regular use of patient-reported outcome measures (PROMs) by health care providers in their routine practice may help to improve the quality of care, but more evidence is needed before routine use of PROMs can be recommended. A structured review was undertaken to examine whether and how regular use of PROMs might improve routine practice. Methods A systematic search of Medline accessed through Webspirs Silverplatter was undertaken for the years 1976-2004. Controlled trials in English evaluating the impact of clinical use of PROMs on routine practice were included. Data regarding study design, characteristics of PROMs feedback, patient populations and study results were extracted by three reviewers. Results Feedback of PROMs results to health care providers appears to have a substantial impact on some processes of care, particularly on diagnosis of mental health conditions. However, the impact on patient health status is less consistent. Most of the published studies evaluated PROMs as a one-off screening technology and measured only provider behaviours and patient health outcomes. Conclusions The pattern of results suggests a general lack of clarity in the field, especially regarding appropriate goals for PROMs and the mechanisms by which they might achieve them. To fully evaluate their role in routine practice, studies need to use PROMs that capture issues of importance to patients and to measure impacts relating to the patient-provider relationship and patient contributions to their well-being. Until studies evaluate PROMs as a means facilitate patient-centred care, their full potential in clinical practice will remain unknown.