PROMs: Moving from Theory to Practice to Delivering Patient-Centric, High-Value Care
Scientific studies show the value of incorporating patient-reported outcome measures (PROMs) into clinical practice. Incorporating PROMs into clinical care improves patient satisfaction, achievement of patient-identified goals of care, and can reduce unplanned care. Considering these benefits, we might assume providers have strategies in place directing the incorporation of PROMs into workflows and systems.
However, moving from study concepts to standard of care is a complicated process. It necessitates a shift requiring both socio-cultural and technical management.
Below are tips to facilitate the process of integrating the use of patient-reported outcome measures into your institution.
How to introduce patient-reported outcome measures (PROMs) into your organization and clinical practice
Gather information
Build a knowledge base by learning from those who have integrated PROMs into practice. The knowledge and insight gleaned from clinicians who have implemented the use of PROMs into their clinical decision and treatment practices is valuable, both the successes and the setbacks they experienced.
My go-to document is the NEJM Catalyst article titled PROMS: Opportunities, Challenges, and Unfinished Business by authors MacLean et al. It showcases their three-year experience with 28 different patient-reported outcome measures at the Hospital for Special Surgery in New York. The article provides a step-by-step framework that is applicable to both specialty and primary care settings. The authors offer insights relevant across the spectrum from large, multi-facility health systems to single-site clinical care offices. Learn from the sound principles of those who have already gone down the path you seek to travel.
Identify goals
Define your goals and complete a baseline assessment of your local needs, current use, interest, and technical capacity to implement PROMs. Compare these findings to established best practices and identify any gaps. Identify local champions who are willing and able to lead early implementation work.
Assess the landscape
Look to national trends and health policy signals. After identifying your local needs and understanding your patient population, investigate any current or upcoming potential requirements related to CMS, NCQA, and medical specialty society incentives or requirements, especially around maintenance of board certification. It’s critical to learn early in the process if specific PROMs are being considered by a national quality performance program. You can then align your local interests and needs accordingly.
Leverage economies of scale
Find common areas of interest with your local payers. Talk with your local health insurance payers to learn of any incentives or program support they may provide to early adopters of PROMs. Both providers and payers benefit from improved patient satisfaction, identification, and realization of patient goals of care, improved patient outcomes and decreased unplanned care.
As health plan quality measure requirements shift to incorporate PROMs, the technical details surrounding coding and data transfers need to be identified and addressed early to minimize reporting burden. A collaborative approach will open lines of communication useful in establishing standards of operation.
Select an execution route
Choose your business model for success. In some scenarios, the integration of PROMs into clinical decision making, workflow, and EHRs systems can be done completely in-house. In others, an outside specialist is needed to help with planning, implementation, and operationalizing a patient-reported outcome measurement program.
Various third-party PRO/PROMs data collection software systems are evolving to include specialized analytics, intuitive user interfaces, and improved integration with EHRs. Your current EHR vendor may also have a patient-facing data collection platform.
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