For anyone who has travelled on the London Metro, “mind the gap” means watching your step between the subway car and the platform when you enter and exit. In healthcare, we are constantly mindful of the gaps we are aware of, but some are more difficult to see. One example is in the way we measure the value of care delivery. Current measurements often focus on observation from professionals and objective clinical data like range of motion, blood pressure readings, and laboratory data. However, we can now incorporate another critically important metric: Patient Reported Outcome Measures (PROMs).
What exactly are PROMs? They are data that a patient provides us about their condition, diagnosis, and/or treatment. Patient reported outcomes are commonly obtained using validated patient surveys that include functional and quality of life measures. Why are patient reported outcome measures important? Because they provide us with the most meaningful data that will help us improve health and well-being.
There is no standard playbook for collecting PROMs. Some organizations will gather data with a traditional hardcopy survey while other providers will use sophisticated information systems. There are many free validated options available and the National Institutes of Health has options available through their Patient Reported Outcomes Measurement Information System (PROMIS). But regardless of the tool, the most important success factors to gathering information are engaged patients and physicians.
Our patients have been intimately involved with the design of our processes. At the physician’s office, our patients can use a tablet, such as an iPad, to enter their PROMs data. Or, the data can be collected via an emailed survey. Paper surveys are also available but most patients prefer a more modern method of collection.
Physician buy-in is also necessary for adoption. Clinicians should be involved in selecting the survey instrument. When it comes to specific survey questions, it’s best to reach a consensus among the physician group. Fortunately, there are many patient reported questionnaire templates available. Specialty societies also have recommendations and specific tools that should be implemented. However, err on the side of simplicity whenever possible. Asking too much can reduce patients’ completion rates. Likewise, physicians should plan to use the information during the visit. But, collecting too much data reduces their ability to leverage it quickly for quality improvement.
The information must be easily understood during a time-limited visit and lead to action. To repeat the often stated mantra, “it’s about the workflow”. HealthPartners clinicians have provided feedback on what information is important to them and where in their workflow it can add value. Additionally, quality resources ensure data is reviewed from a population perspective for administrative leadership.