Patient-reported outcomes as the next frontier in quality measurement
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 on the left sided concepts through process measures and HCAHPS surveys, the concepts on the right, arguably some of the most important aspects of a patient’s outcome, are left to clinician follow-up and are rarely reported or used in a systematic way.
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 often recorded 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 adequately discuss sensitive issues.
Patient-reported outcomes offer a way to capture a 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 into tools that engage patients in their care, that 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 and their clinicians 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.
As payers reorganize around value, we’re beginning to see a shift from process measures and crude outcome measures to longer-term and more patient-centered outcome measurement. The Comprehensive Care for Joint Replacement mandated bundled payment program from CMS was one of the first examples of a program that included specific financial incentives for collection and reporting of PRO data. It is inevitable that we will see more and more programs from both CMS and private payers incorporating such kinds of incentives. Measuring and using patient-reported outcomes to optimize care will not only be the right thing to do by your patients but will become a necessity to thrive under these new payment models.
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. Some of the barriers that top researchers, organizations and companies like ours are breaking down every day 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: Few have had access to this kind of data before. We need to build tools to visualize and interpret this data that integrate in to workflows and give us a more holistic and actionable view of the patient or our populations.
Now is the perfect time to start putting patient-reported outcomes to work in your practice. We hope this article was interesting and helpful and inspires you to action. If you’d like to join us on the journey simply sign up or get in touch we’re always keen to talk about customer goals, challenges and share any of our knowledge that might be useful!