Why patient-reported outcomes matter
Put yourself in the shoes of a clinician and think of a recent treatment you delivered. Now consider how you judged whether that treatment was successful. You’ll probably think of some of the following:
While current quality measurement and reporting attempts to capture data around the 1st items through process measures and HCAHPS surveys, the 2nd items, arguably the most important aspects of a patient’s outcome, are left to clinician follow-up. As we all know, time pressured clinical environments, inadequate data collection systems and limited capacity to follow-up with patients mean these outcomes have to be assessed on the spot and recorded, often with a brief scribble in the notes. Furthermore, studies have shown that patients are often reticent in sharing details in person and clinicians often find it difficult to surface sensitive issues such as sexual function.
Patient-reported outcomes offer a way for capturing more meaningful, complete and longitudinal perspective of the factors that are so fundamental to assessing a patient’s outcome. Modern technology presents the opportunity to translate patient-reported outcome measures from static paper instruments used in small-scale research studies to tools that engage patients in their care, can be deployed at scale and provide real-time insight in to patient outcomes like never before.
This new found insight can help clinicians optimize the care they deliver by finally capturing feedback across the entire cycle of care with a full view of the outcomes that matter. Data can be used to identify patients at-risk before or after treatment and target customized care plans or proactive outreach. Patients can make shared-decisions about treatment based on outcomes data from matched patients that have gone before them. Both providers and payers can use data to help demonstrate value, justify reimbursement and better align incentives.
Of course none of this comes without challenges but we believe that the confluence of value-driven care, the ubiquity of connected devices and the era of personalized & patient centered care make it a compelling time to be tackling this fundamental problem in healthcare. Specifically some of the challenges that lie ahead that we and our partners are actively tackling include:
Measure development: Fields like orthopaedics have a wide range of broadly validated measures with adoption among payers and large condition based registries. In some other specialties the measures are less mature but that’s changing every day.
Standardization: In order to make useful comparisons across populations a degree of standardization is necessary both on the measures used and the timescales for data collection. Organizations like ICHOM and payers like CMS are helping put people on the same page.
Technology: We need secure technology that engages patients and enables them to communicate on their terms through any device. That data needs to flow back to the care team in real-time and be easily accessed at the point of care.
Interpretation of Data: Very few have had access to this kind of data before. We need to build tools to visualize and interpret this data that fit in to workflows and give us a more holistic and actionable view of the patient or our populations.
Adoption in Payment Models: We’re already seeing PROs play a part in the CMS Comprehensive Care for Joint Replacement and MIPS programs. We’re likely to see continued movement from payers, both private and public, as they seek to align around value.
As we break down these challenges every day, the question is where you’ll be
Did the patient develop any immediate complications or need to be readmitted?
Did the patient die as a result?
Did the patient’s biomarkers indicate a successful treatment?
Did the patient have a good treatment experience?
Did the patient develop any long-term complications due to treatment?
Did the patient adhere to the treatment?
Did the patient notice a significant improvement in their symptoms?
Did the treatment improve the patient’s functional status?
Has the treatment led to an improvement in the patient’s quality of life and mental well-being?
Did the treatment meet the patient’s own goals in proceeding with the treatment in the first place?