While the benefits of Patient Reported Outcome Measures (PROMs) programmes are well established and significant, at Cemplicity we often hear frustrations from health providers about how they can’t agree on how best to deliver PROMs across their organisation. The challenges arise because PROMs programmes are typically trying to solve two valid, but often conflicting, objectives:
- System-level quality improvement, value assessment and service redesign
- Improved clinical outcomes for individual patients
A scenario we often come across is a hospital executive team wants to implement a system-level process to get a sense of the quality improvement delivered by all services, relative to each other. By asking a generic set of quality of life questions across all patients at the same points in their journey, management can analyse a comparable, consistent data set across the whole system. This, will allow them to make decisions on needs of each service, as well as show funders of health care where the value is being delivered. It also sets them on the path to value-based healthcare.
However, the suggested approach from management has met significant resistance from the clinical teams. The ophthalmologists are concerned that their cataract patients are not getting asked specific questions about their eyesight, and that the second data point is well after their follow up consultations and therefore useless in helping assess the effectiveness of their procedures and post-op treatment plan. The orthopaedic surgeons meanwhile feel that quality of life metrics are not enough for their knee replacement surgeries – they want to understand before and after the operation much more about their knee function – their ability to walk without pain, kneel and so on. The system-level approach suggested by management therefore won’t meet the needs of either clinical team fully, and as such, results in resistance to adoption and most importantly, misses the opportunity to create a better health outcome for the patient.
While the example above is not unusual, this does not mean the situation is hopeless. In fact, with careful consideration, a win/win can be achieved for all stakeholders. In our experience, the most successful PROMs programmes, are those that recognise these two objectives and the potential for conflict between them. Through effective implementation of the following 6 Success Factors, great outcomes can be achieved for patients, clinical teams and management – specifically:
- Get the question mix right – combine generic quality of life measures with condition-specific questions to meet the majority of the everyone’s needs
- Be flexible in timing – establish some cornerstone system-level data points, but then let clinical teams offer other capture points that suits their specific patient journey and clinical milestones.
- Make it seamless for patients – Regardless of the questions and timing, the patient should feel that it’s easy, and a logical process in place to capture their feedback without a sense of duplication or confusion.
- Keep it real-time – It’s critical for shared decision making that reporting and alerts are available as soon as a patient responds with their feedback.
- Store all data in one place – all PROMs data should reside on a single platform so that all stakeholders must be looking at the same data.
- Be pragmatic – recognise the twin objectives and the inherent conflicts within them. But also agree that benefits can be achieved for all stakeholders with a little bit of compromise and respect for each other’s goals.