Patient-Reported Outcomes in Primary Care-New York (PROPC-NY)
The U.S. health care system is undergoing an unprecedented transition, marked by a new focus on value rather than on volume. While meaningful quality measures are critical to defining health care value, the majority of measures today assess what care is provided, as opposed to whether that care made a difference on outcomes that matter most in people’s lives. Research has shown that patients’ and physicians’ perceptions of outcomes differ, and that taking into consideration patients’ views of their health status—or Patient-Reported Outcomes—can lead to more effective interventions.
Patient-Reported Outcome Measures, or PROMs, consist of validated questionnaires to elicit patients’ views of their health. They can be used to assess symptoms, health-related behaviors, and degrees of physical, social, and emotional functioning. These instruments provide results that allow clinicians to establish a baseline and to track the effects of treatment over time; importantly, they help the provider and patient create a plan of care that aligns with patients’ goals. When incorporated into electronic health records, PROMs can provide a central information resource for multi-disciplinary care teams and a tool for enhancing team communication and care coordination.
UHF’s Quality Institute is advancing the use of PROMs as a vehicle for better engaging patients and lending weight to their voices in the delivery of high-quality primary care in New York. The PROPC-NY initiative, supported by the Engelberg Foundation, has created an 18-month learning collaborative involving three New York-area health care organizations, a faculty of nationally recognized experts, and the UHF Quality Institute.
Activities and Outcomes
While there is a high level of interest in and growing work on PROMs, little attention has been paid to their application and potential value in primary care. Through the PROPC-NY initiative, the Quality Institute seeks to:
- Test the feasibility of routine collection and use of patient-reported outcomes to improve care planning and its impact in ways that matter to patients, especially those facing complex health challenges and difficult socioeconomic circumstances;
- Identify best practices related to patient questionnaires—when and how to collect information from patients, how to use responses to create care plans, how to operationalize re-assessment, continued monitoring, and goal attainment, and how to assess the impact of care plans on patient health and well-being;
- Advance knowledge of PROMs among primary care providers in New York and nationally as the field of patient-reported measurement grows and value-based payment spreads.
The PROPC-NY learning collaborative involves three metropolitan-area health care providers:
- The Institute for Family Health, a federally qualified health center (FQHC), and its Urban Horizons Health Center in the Bronx;
- Montefiore Health System’s South Bronx Health Center and Center for Health and Resiliency; and
- Northwell Health and two faculty/residency practices within the Division of General Medicine that serve patients in eastern Queens.
Significant federal investment in PROMs is likely to lead to their continued uptake and diffusion in clinical practice in the near future. With support from the National Institutes of Health, the Patient-Reported Outcomes Measurement Information System (PROMIS) has produced and validated a set of assessment tools that has become the standard for measuring outcomes in federally funded research. Groups such as the National Quality Forum, the Patient-Centered Outcomes Research Institute, and the National Committee for Quality Assurance are exploring ways that PROMs can be used to measure relevant health outcomes in national reporting and value-based payment programs such as Medicare’s new Merit-based Incentive Payment System. The Centers for Medicare and Medicaid’s bundled payment initiative for hip and knee replacement surgery provides a financial incentive for use of a PROM at baseline and post-surgery.