Misconceiving patient reported outcome measures (PROMs) as primarily a reporting requirement rather than a quality improvement tool: perceptions of independent healthcare sector stakeholders in the UK (original) (raw)
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Journal of patient-reported outcomes, 2018
There is increasing interest in using Patient Reported Outcome Measures (PROMs) within organisations delivering health related services. However, organisations have had mixed success in implementing PROMs and there is little understanding about why this may be. Thus, the purpose of this study was to identify the facilitators and barriers to implementing PROMs in organisations. A systematic review of reviews was undertaken. Searches were conducted of five electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews, during the week of the 20th February 2017. Additional search methods included website searching and reference checking. To be included, a publication had to be a review of the literature, describe its methods and include information related to implementing PROMs. The reviews were extracted using a standardised form and assessed for their risk of bias using the Risk of Bias in Systematic Reviews tool. The findings were synthesised...
BMC Health Services Research
Background Patient reported outcome measures (PROMs) can be used by healthcare organisations to inform improvements in service delivery. However, routine collection of PROMs is difficult to achieve across an entire healthcare organisation. An understanding of the use of PROMs within an organisation can provide valuable insights on the purpose, scope and practical considerations of PROMs collection, which can inform implementation of PROMs. Methods We used multiple research methods to assess the use of PROMs in research projects, data registries and clinical care across a healthcare organisation from January 2014 to April 2021. The methods included an audit of ethics applications approved by the organisation’s human research ethics committee and registries which the health organisation had contributed data to; a literature review of peer-reviewed journal articles reporting on research projects conducted at the organisation; and a survey of health professionals use of PROMs in researc...
Qualitative Health Research, 2019
The NHS routinely evaluates the quality of life of patients receiving hip or knee replacement surgery using patientreported outcome measures (PROMs), but some hospital completion rates are only 30%, restricting data usefulness. Statistics limit insights into how and why data are missing, so qualitative methods were used to explore this issue. Observation periods preceded semistructured interviews with 34 preoperative patients attending an orthopedic outpatient clinic. Interview themes covered: completion time/timing, orientation, setting, measures, and practicalities. Triangulated against observations, pragmatic barriers, and facilitators were considered. Refined themes included completion conditions, patient support, and national delivery. Simple improvements (e.g., quiet zone) could improve completion rates and reducing missing data. Reorganizing preoperative leaflets and their systematic distribution via standardized procedures could reassure patients, enhancing PROMs acceptance, while reducing inquiries and subsequent staff burden. Findings have implications for interpreting national statistics. They indicate that further debate about mandating preoperative PROMs is due.
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
Managing by numbers: using outcome measures in the NHS
International Journal of Health Care Quality Assurance, 1999
The paper explores the literature concerning outcome measures used in health services. The need to measure outcomes subsequent to encounters with health services has been identified and occurs as a result of the current "value for money" approaches being used within the NHS. Provider units are required to establish the effects which interventions have had on the health of each individual using their services, despite the fact that definitions of health outcomes used by both professionals and managers are problematic. It is suggested here, however, that outcome measures which answer all requirements will remain elusive, and their effectiveness will vary according to the circumstances of their generation and use. Moreover, the very use of outcome measures as management tools can lead to a subversion of the meaning which led to their selection in the first place. Managing by (outcome measure) numbers is not a realistic way forward.
Implementing PROMs in routine clinical care: a qualitative exploration of GP perspectives
BJGP Open, 2020
BackgroundThe recently announced long-term plan for the NHS is based on a model of person-centred care, which relies on the sustained engagement of patients, shared decision making, and capability for self-management. For a primary care service under increasing pressure from an ageing and chronically ill population, Patient Reported Outcome Measures (PROMs) appear capable of supporting many of the requirements for person-centred care, yet little is known of the circumstances of their current implementation or how their use might be optimised.AimTo begin the conversation about how successfully PROMs have been integrated into primary care and how their use might be supported.Design & settingA qualitative investigation of the perspectives of GPs exploring the use of PROMs as part of routine clinical care in England.MethodSemi-structured telephone interviews were conducted with GPs from across England. The data were analysed using the Consolidated Framework for Implementation Research (...
The Role of Patient Reported Outcomes (PROs) in Healthcare Policy Making
Systematic Reviews in Pharmacy, 2016
Patients are the most valuable and authoritative source of information on outcomes like health-related quality of life, functional status, symptom and symptom burden and health behaviors. However, even traditionally, the only information collected from patients was feedback on satisfaction or experience with care. Patients have always remained an untapped resource in assessing the quality of healthcare and of long-term support services. The scenario has however changed with the increasing realization of Patient-Reported Outcome Measures (PROMs) as an efficient quality improvement tool. Routine collection of patient-reported outcomes (PROs) to inform, compare and manage healthcare professionals and facilities are implemented in a number of countries, including England, Australia, United States of America, Sweden, and the Netherlands. This review article discusses examples of PROMs in routine practice in some countries to illustrate the importance of building capacity and infrastructure to capture PRO routinely and utilize that data for developing performance measures for assessing provider's quality and efficiency. Also, discussed are the barriers to implementation of PROMs and factors responsible for its minimal influence on patient outcomes and ineffectiveness in comparing hospital performance. Finally lesson for health care policy makers especially Indian health care policy makers for successful implementation of PROMs are summarized.