A specific form of data is gaining traction among providers that has the potential to better measure and assess patient outcomes, especially in terms of quality of life. Patient reported outcomes (PROs) are clinical questionnaires completed by patients that help providers assess a patient’s quality of life, including activities of daily living, depression symptoms, pain rating and fatigue. PROs are unique in their assessment of patients in that they try to evaluate and understand the effectiveness of the care that is provided through measuring symptoms and quality of life. This is in contrast to the traditional HCAHPS approach, which measure a patient’s satisfaction. Both of these measurements carry great significance and should both be considered as part of clinical care. A patient can have a positive experience in the clinic and with the provider, but if the care plan is not resolving the patient’s symptoms, then the care plan needs to be adjusted. This is where PROs can be leveraged and are a key reason why providers are seeking out the adoption of this type of tool to assess clinical care across episodes of care, procedures and clinical trials.
This article outlines:
- Why there is increased interest in implementing PROs
- Challenges implementing PROs
- Considerations for effective and sustainable PRO strategy implementation
- Leveraging PRO data to drive clinical outcomes
- Applicability of PROs across healthcare sectors
The use of PROs align to three major health trends including patient-centered care, consumerism and the growth of precision medicine. PROs can be used to help patients make more informed choices related to their care, help health systems benchmark outcomes across settings, help researchers align patient perspectives with outcomes and monitor patient progress against treatment goals. PROs are particularly helpful in cancer patient populations to assess negative effects of therapy, need for supportive care, targeting specific symptoms, and even determining preference between standard and new treatment plans.
PROs can also be leveraged to assess outcomes, particularly related to surgeries and pain management. This supports more informed conversations between providers and patients and can be leveraged to meet MIPS/MACRA quality metric requirements. “Conclusively, PROs are unique indicators of impact of disease on the patient, helpful in empowerment of the patients, necessary for determination of efficacy of the treatment, by communication helpful in creating a rapport between patient and healthcare providers, useful in the interpretation of clinical outcomes and treatment decision making.” 1
CHALLENGES RELATED TO PROs
While there are known clinical benefits to leveraging PROs, only “a fifth of hospitals routinely use patient reported outcome measures to understand patient care outcomes, 73% of survey respondents indicate they plan on integrating PROs into their data collection strategies within the coming 2-3 years.” 2 One of the keys to improving the ability to leverage PRO data is to collect the data across patient populations consistently on large scale rather than in small-scale research study approach. The challenge for many organizations is how to operationalize these clinical tools strategically.
Challenges include measure and tool selection, licensing requirements and how patient friendly the PRO tools are. Patient adoption may be encouraged by the use of technology such as tablets and patient portals to collect the PRO questionnaires, but they can present their own challenges including technical build functionality and integration considerations. Finally, organizations should consider how the data collected will be used in a meaningful way.
Here are 4 considerations for how to implement and operationalize PROs across an organization:
1. Create Strategic Alignment with the Right Stakeholders
Establish strategic alignment with population health, patient portal, and connected health device health stakeholders to leverage existing functionality, develop new integrated workflows and collaborate on how to use collected data for a more holistic and comprehensive view of the patient to drive better clinical outcomes.
2. Establish Governance for Decision Making
Responsibilities could include:
- Developing a request process
- Prioritization criteria
- Custom build evaluation criteria
- Promoting standard objectives
- Serving as a liaison for legal around license requirements
- Advocating for resources
- Assessing and communicating PRO outcome data
- Develop, document and train best practice workflows
- Advising on how to best leverage data collected to drive clinical decision making and outcomes
- May also serve to advise on other initiatives such as patient history questionnaires
3. Streamline Data
Streamline the collection of PROs by building them within the electronic health record (EHR) for multi-modal delivery approach across the patient portal, smartphone apps, kiosks and tablets. These approaches remove the need for clinicians or staff to manually key in data and allows patients to directly input their answers, which may lead to more honest answers than answering the questions verbally. EHR partners may also be able to advise on technology selection and configuration, sophisticated branching logic, scoring capability and assignment to patients based upon clinical/operational data.
4. Create Value with PROs
Considerations will need to be made around what data modeling tools will be made available to support the use of PRO data without large, error-prone, and manual Excel spreadsheets. The goal would be to use clinical data in real-time for maximum benefit. Additionally, the PRO committee will need to report out system-wide metrics on utilization and collection, which will communicate impact and value of the strategic initiative and advocate for additional resources and functionality.
CROSS SECTOR IMPACT
While the use of PRO questionnaires is gaining traction within the provider sector, they are not new to the healthcare industry at large. PRO questionnaires can be leveraged across life sciences and payers.
Within the life sciences, PRO data can assess drug effects, dosing, side effects and treatment plan adherence. One survey with “22 responses from 18 companies revealed that the adoption of ePRO will continue to rise, as it is still a relatively new addition to clinical research programs. More than 60% of respondents said their companies began using ePRO in the last 5 years, while 11% have been using ePRO for more than 10 years.
Meanwhile, adoption is also expected to increase for those that do not use an ePRO. More than three-quarters of respondents expected that there would be increasing ePRO usage for post-marketing trials for primary and secondary endpoints.” 3
Additionally, PRO data can be leveraged across patient populations via new models to predict outcomes across demographic and geographic segments to improve cost containment measures for payers. This is a key underpinning of the shift from fee-for-service financial agreements to risk-sharing agreements, where stakeholders will be even more incentivized to share these types of patient reported data sets and leverage new data models to interpret and operationalize the data for clinical decision making. The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology is also increasingly focusing on patient reported outcomes to benchmark care among providers and potentially impact value-based reimbursement contracts. 4
- Deshpande, Prasanna R., et al. “Patient-Reported Outcomes: A New Era in Clinical Research.” Advances in Pediatrics., U.S. National Library of Medicine, 2011. View in Article
- Heath, Sarah. “Using Patient-Reported Outcomes Measures to Improve Engagement.” PatientEngagementHIT, 1 Dec. 2017. View in Article
- Brennan, Zachary. “CROs plan to increase use of ePRO tech.” Pharma.com. 13 January 2015. View in Article
- Hostetter, Klein. “Using Patient-Reported Outcomes to Improve Health Care Quality”, 2018. View in Article