Amid Technological and Cultural Barriers, Patient-Reported Outcomes Poised to Make a Splash
Hospitals that use PROs report a significant impact on quality improvement.
A quality measurement that focuses on patient symptoms and overall quality of life if poised to take on a greater role in patient safety. In some parts of the country, it already has.
Patient-reported outcomes (PRO) defined by the National Quality Forum (NQF) as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else” have been generally underutilized by the healthcare industry. According to a survey published by HeatlhCatalyst in August, fewer than two in 10 hospitals use PROs even though the measurement can provide a new and valuable perspective into each patient’s condition and, when adequately tracked, offer a more detailed look at the potential for quality improvement with specific areas of care.
As a practitioner, I find it incredibly useful to look at the patient-reported information data,” says Carolyn Kerrigan, MDCM, MSc, a professor of surgery at the Dartmouth Institute and a surgeon at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. “It tells me a lot very quickly and it actually saves me time. A lot of providers think it’s going to be more work if we do this. In fact, it makes your work more efficient.”
Hospitals may be gearing up for a surge in PRO usage. Nearly three-quarters of respondents in the HealthCatalyst survey that said they “rarely” or “never” use PROs said they plan to start within the next one to three years.
New payment initiatives may be one important driver behind the push to use PROs. CMS’ new value-based Comprehensive Care for Joint Replacement (CJR) model, which began in April, incorporates voluntary submission of PROs for hip and knee replacements. Under the proposed Merit-based Incentive Payment System (MIPS), CMS has identified PROs as a “high-priority for future measure consideration.” Overall, PROs offer a better look at how patients are truly feeling and whether or not certain medical interventions are making a difference in their quality of life.
“Patient-reported outcomes are critical to enabling healthcare’s evolution away from focusing on the volume of services delivered to the value created for patients,” said Paul Horstmeier, senior vice president of Health Catalyst, in a press release. “Their use promises seismic changes not only in the way providers are paid, but how they measure success, how patients choose their doctors, and most importantly how clinical outcomes are improved. Yet with few exceptions, our nation’s hospitals are unprepared for the shift and need help managing this new priority within the ever-shifting field of time-intensive regulatory requirements.”
The few hospitals that have explored PROs have reported optimistic results. For example, Dartmouth-Hitchcock Medical Center has been incorporating PROs to some degree since 1999. Since 2011, when it switched its electronic medical record (EMR) system to EPIC, the healthcare provider has been feeding PROs into patient EMRs so that clinicians can have relevant information at the tip of their fingers.