Supported by a grant from the Engelberg Foundation
Health care today is undergoing an unprecedented transition, marked by a new focus on the value of services rather than their volume. While meaningful quality measures are critical to defining health care value, most measures today enumerate and assess what care is provided, but not whether that care makes a difference in the outcomes that matter most in people’s lives. Research has shown that patients’ and physicians’ perceptions of outcomes differ, and taking into consideration what are known as Patient-Reported Outcomes—essentially patients’ views of their health status—can lead to more effective interventions.
Patient-Reported Outcome Measures, or PROMs, speak to that challenge, using validated questionnaires to elicit patients’ views of their health. Such measures allow clinicians to establish a baseline and track the effects of treatment over time, and help create a plan of care that aligns with patients’ goals.
Significant federal investment in PROMs is likely to lead to broader adoption of these measures in the near future. Among recent steps encouraging continued uptake:
- 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;
- The National Quality Forum, Patient-Centered Outcomes Research Institute, National Committee for Quality Assurance, and other groups 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 Services’ bundled payment initiative for hip and knee replacement surgery is now providing financial incentives for PROMs use at baseline and post-surgery.
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 utilizing patient-reported information—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.
An implementation guide and several field reports from participating providers are available here.