Patient Reported Outcome Measures (PROMs) are becoming increasingly popular for payers and regulators to assess the value of services being delivered. This can create tension, if the clinical community feels they are being forced down a particular road that is not conducive to better decision making or that cuts across the relationship between doctor and patient.
It doesn’t have to be this way though. There is an alternative approach in which PROMs can meet the needs of clinicians and your patients, as well as those of payers. After all, if a patient is going to take the trouble to talk about their own health, then the onus is on the health system to maximise the benefit of that effort.
Asking patients the right questions
Many of the objections we hear from clinicians arise when they are expected to use generic quality of life surveys or other PRO not suited to their specialism, leading to results that are not particularly actionable. In a clinician-led PROM programme, you can select the condition-specific PRO most suited to your service and goals, optimising the full-value of the feedback.
Beyond this, you can include an additional question in the patient’s baseline (pre-treatment) PROM, asking the patient to describe their goal for seeking treatment. Their response is available to the clinician in time to discuss this face to face prior to treatment, improving shared decision making and highlighting areas for further discussion and clarification.
Ask them in the right way
As a start, patient feedback must be solicited by means most convenient for the patient and the clinical team. Any modern PROMs programme will use a combination of modes, starting with email, then SMS when an email address is not available, before topping up missing responses with tablets, which can be handed to the patient upon arrival in the clinic. This method of surveying minimises cost and staff administration, while optimising response rates and patient reach.
A digital approach means it is also possible to add patient comment fields to validated PROM survey tools. Patients are much more likely to be open and frank in comments when taking part in the comfort of their own home and at a time that suits them. It can also enhance engagement with individual patients by opening up communication in a timely way, allowing patients to talk about their goals and concerns, and prompting patients to monitor and self-report their symptoms accurately. Qualitative feedback gives context to the outcome measures and this is shown to give further insight to the clinical team.
Timing is everything
A typical PROM can ask a patient about their health state prior to treatment, during treatment and then again post treatment. Where PROMs are used to measure outcomes with long term conditions, a person may be surveyed at regular intervals over their lifetime. The needs of the payer may be less frequent than those of the clinician – a good solution caters for both.
Real-time easy access
Clinicians can only use PROMs data when it’s readily available when they need it. Ultimately, even if a patient fills in their outcomes while sitting in the waiting room, the clinician should be able access the data in a consultation. This is the key to having real-time feedback.
Digital capture of PROMs facilitates the opportunity to create a pro-active alerts mechanism so that the care team can be aware of issues from a patient’s perspective, even if that patient is completing that PROM from home. More sophisticated tools can take these thresholds to another level in which alerts are triggered based on adverse movements in the PROM based on previous responses from the patient.
A well-designed, clinically-led PROMs programme can be a significant contributor to improved clinical practice, allowing clinicians to test and refine care strategies and monitor outcomes for different patient cohorts outside the care setting.