Cemplicity has learnt that a successful Patient-Reported Outcomes Measures (PROMs) programme boils down to two critical factors: Strategic collaboration with clinicians and the optimisation of response rates. It sounds simplistic, that clinical staff and patients must be involved if PROMs are to have an impact on clinical outcomes but, like all good insights, the insight is simple but the underlying data is complex.
Over recent years, we’ve got to know many PROMs survey owners as well as regulators, insurers and public and private providers across many countries and health systems. Oddly, we’ve learnt more from PROMs that haven’t worked – where they haven’t led to any demonstrable improvement in shared decision-making, health outcomes or system value.
A challenge for newcomers to PROMs is that this is a dynamic field. Healthcare services are changing, technologies are advancing, new research is being released and health system priorities are changing in a world of increasing inequity and pressured workforces. All of this influences how PROMs should be brought into a health service to have impact.
Yes, it is important to choose the right survey instrument, to optimise digital data capture and to ensure the process is highly automated, secure and timely. But, if your clinical staff aren’t fully supportive and engaged, and you’re not achieving strong response rates, the results will not be reliable or widely used.
The role of clinicians in a PROMs programme
The purpose of any healthcare initiative is to optimise patients’ outcomes, with the best use of available resources.
PROMs sit alongside clinical outcome measurement to help clinicians assess the best treatment options with patients, enhancing better shared decision-making. They also provide an objective measure of health outcomes which is increasingly important when patients are having less time in front of clinicians for face-to-face assessments e.g. shorter stays in hospital, less frequent outpatient visits or receiving remote healthcare services.
PROMs are also increasingly used to signal clinically significant changes in a patient’s health and alert clinical teams when patients are at home but when intervention is needed.
At a system level, PROMs are commonly part of a value-based healthcare funding mechanism, used to measure the quality of services being delivered alongside costs.
None of these strategies work without clinical support. Without a guiding hand in the PROMs programme planning, clinicians are less likely to use the patient feedback in their consultations with patients, they may resist introducing PROMs-driven alerts into their service and they may question the validity and reliability of PROMs results when discussing value assessments.
It is imperative to recognise clinicians as key partners from the outset of PROMs programme planning.
Why is this so important?
- People support what they help create. Involving clinicians early allows them to table all their earlier PROMs experiences and concerns so that these can be understood and addressed early.
- Clinicians often have preferences on the best PROMs surveys to use. Reaching consensus is important and may involve combining several different surveys into one programme.
- PROMs data collection must be automated and integrated with clinic workflows to minimise the burden on staff and optimise response rates. Frontline staff need to actively guide the programme design so that it works closely with the workflows.
- Different staff will need to see different results. It’s important to deliver the right insights to the right people, but not to share too much data nor create complexity.
- Clinicians must lead the decisions on algorithms, triggers and alerts so that the right type and severity of symptoms are identified, the right staff are notified, and the right action is taken.
- A major barrier to the use of PROMs in value-based funding systems is when clinicians do not believe fair, like-for-like benchmarking is occurring. This can be mitigated by ensuring the right additional data is matched to each patient PROM and used for benchmarking.
Finally, working with supportive clinicians will help you tailor your messaging about your new PROMs initiative effectively to achieve wide support.
A well-implemented programme will be of value to clinicians in their day-to-day interactions with patients, provide rich data for improvements to patient pathways, and meet funders and quality agency needs for transparency. Only by close engagement with clinicians can all these powerful value-drivers be unlocked.
Optimising PROMs response rates
The most common question we are asked when organisations are considering PROMs is ‘what response rate can we expect’. Everybody understands that high response rates are critical to the reliability and usability of the data.
This all starts with optimising your baseline responses (i.e. the patient surveys received prior to treatment). Our (not always achieved) aim is to achieve 95% or more of your patients completing the baseline survey and this can only be achieved by fully integrating data capture with the patient pathway into your facilities.
Our experience has consistently shown that clients who proactively invest in setting up their programme and who follow our direction tend to achieve the highest baseline and overall response rates.
It is essential to understand that optimising response rates is not a ‘set and forget’ task. Staff change and communication providers (like email and SMS messaging providers) change their rules and algorithms without notice. The structure or content of your patient management system might change, affecting the data exchange with Cemplicity and therefore the survey invitation cycle.
Importantly, Cemplicity are continuously conducting A;B testing in each country and testing strategies like copy writing, time of day, reminder frequency and timing to see what impacts on response rates for different patient demographic groups. We are regularly monitoring response rates across our global client base to spot outliers, learn from the high achievers and to recommend tweaks to other clients to lift their response rates.
The critical factors to achieving high PROMs response rates include:
- Educating and communicating the importance of their involvement to the patient at the start of their journey. We help you develop a communication plan that explains the programme and why their feedback is important to their overall care.
- Making it easy for patients to give feedback. Have a multi-mode approach to collecting responses. Prioritising digital methods (Email, SMS, Tablet or QR-Code) can maximise the reach of responses and streamline the automation into existing care pathways easily.
- Ensuring that staff understand the purpose of the programme so they can communicate it’s importance confidently to patients.
In summary, there are many more factors to incorporate into a successful PROMs programme but clinical involvement and strategies to optimise patient participation are often the elements that are overlooked.