The growing impact of using patient-reported outcome measures (PROMs) in clinical care
One of CMS’ stated priorities is to elevate the patient’s voice. This priority was further emphasized in March 2021 with the introduction of the Quality Measurement Action Plan, Meaningful Measures 2.0, presented during the 2021 CMS Quality Conference.
There are multiple ways to achieve this goal. Meaningful metrics include functional status and patient-reported outcome measures. Patient-reported outcome measures (PROMs) continue to offer evidence of benefit to patients, providers, and payers. Beyond the role PROMs serve in directing patient care plans, they also play a role in value-based payment and accountable care programs.
Patient-reported outcome measures across multiple healthcare settings and conditions
PROMs have been implemented in clinical environments and show benefit in multiple situations in both inpatient and outpatient settings, such as elective surgeries and management of acute and chronic conditions. Below are a couple of examples of how patient-reported outcome measures are used in different clinical environments:
Use of PROMs in orthopedics
Orthopedic research and clinical teams have validated the benefit of patient-reported outcomes, not only for pre and post-surgery quality improvement, but also as an essential component of shared decision making for joint replacement surgery. When PROMs are integrated with other clinical data using new predictive analytic platforms, clinicians can proactively identify surgical cases at the pre-operative stage that might result in a suboptimal outcome. That valuable insight helps care teams avoid major surgeries with a low likelihood of success and instead address the condition with non-surgical treatments.
Use of PROMs by the general population and persons with chronic conditions
Patient-reported outcome measures provide patients with a standardized means to express their condition-specific health goals, perceptions about the care received, routine task capabilities and activity levels, general well-being, and offer insight into patient progress toward desired outcomes.
The Patient-Reported Outcomes Measurement Information System (PROMIS®) tool is an assessment with over 300 measures of physical, mental, and social health. It’s designed for use with the general population and persons living with chronic conditions. PROMIS established new ways for clinical information collection, use, and reporting.
PROMs used in patients with multiple chronic conditions have the opportunity to predict unplanned care, emergency department (ED) visits, and hospitalizations. This establishes potential to integrate it with risk stratification in population health tools. Use as a risk identifier can be valuable to providers both in and out of ACO’s, as well as payers delivering care management interventions.
A few advantages of using patient-reported outcome measures
We’re in an era of the increasing administrative burden of quality measurement, and it’s necessary to simplify and drive meaningful measures to help lessen that load.
In the face of these and other challenges, PROMs have the added benefit of driving higher patient satisfaction when used to inform clinical decision-making and improve provider satisfaction.
Health equity can also be advanced with PROs/PROMs. Commercial, off-the-shelf technology, including mobile phones, can successfully engage disadvantaged patients collect patient-reported outcomes. The data collected can be integrated into patient electronic health records.
PROs and PROMs may also prove to be effective with new conditions, such as COVID long-haul. The presence of fluctuating patient symptoms and functional status, primarily experienced outside of acute healthcare settings, can be captured for clinical decision-making purposes.
What’s holding patient-reported outcome measures back?
As the evidence on the positive impact of patient-reported outcomes and PROMs continues to increase, barriers remain. Widespread adoption requires rigorous use of standards, creation of more digital measures, seamless integration into workflows, and two-way integration with both electronic health records and care management software platforms.
In the NEJM Catalyst article titled PROMS: Opportunities, Challenges, and Unfinished Business, authors MacLean et al. cite the single largest hurdle as the intensity of resources needed to incorporate PROMs into clinical workflow. They emphasized standards for PROM collection through EHRs need to be defined and vendors required to use them.
Prioritize the steps on your journey to PROMs adoption
As interest grows to incorporate patient-reported outcome measures into value-based and accountable care programs, its essential implementation begins in clinical areas where the use of PROMs will show the most value. This includes:
- High-cost health conditions where patient-reported outcomes and preferences can significantly impact the delivery of appropriate care and total cost of care
- Conditions with increasing provider uptake of shared decision making or increased requirements for shared decision making
- Conditions where PROMs are particularly useful, and may be the only method to measure patient status, such as oncology, orthopedics, and behavioral health
Alternative payment models and managed care programs that focus on patients with multiple chronic conditions (especially those receiving in-home care) are aligned with the use of PROMs. For example, in complex conditions such as end-stage renal disease, PROMs can be important in adjusting treatment and managing transitions to home or center-based dialysis.
Home and Community-Based (HCBS) managed care programs have many members with evolving functional status. Patient-directed, goal-oriented care is enabled by the use of PROMs. PROMs should be considered for use in these payment programs.
When incorporating PROMs into value-based programs, selecting PROMs that have been tested and successfully used in multiple sites or programs is critical. To this point, both CMS and NCQA have pilots in place testing new applications.
As we are in the very early stages of incorporating PROMs into alternative payment models (APM), the standardization of a common set of patient-reported outcome measures used across multiple payers (private, state, and federal) and providers will accelerate the successful adoption and realization of value to all.
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