A Better Way of Collecting Patient-Reported Outcomes

As the healthcare industry seeks ways to improve care quality, collecting patient-reported outcomes (PROs) data has become an increasing point of emphasis for healthcare organizations. However, many organizations lack a means of seamlessly and accurately collecting this critical patient information.

Bronwyn Spira

PROs are usually gathered from a variety of sources, such as patient surveys that request information on health status, quality of life, and functional capabilities. By contrast, patient-reported outcome measures (PROMs) are a standardized set of forms that are typically used across registries for a specific procedure. For example, a common PROM used to assess patients who have undergone a hip replacement is the Hip Disability and Osteoarthritis Outcome Score.

For payers, measuring previously non-quantifiable outcomes data — including symptoms, activities, functional status, and mental health — helps to assess provider performance. For providers, PROs are important because health systems must submit validated patient data to demonstrate compliance with certain quality standards and earn recognition by accrediting bodies and Centers of Excellence programs.

Already, the industry is moving toward collecting data on patient outcomes. For example, 24% of clinical data registries have already incorporated PROs into their datasets, according to the Council of Medical Specialty Societies. Additionally, many health plans require providers to report PROs to participate in value-based care arrangements, and accountable care organizations use patient outcomes measures to incentivize providers to maintain quality standards.

The CMS has set the goal that by 2030, all Medicare fee-for-service beneficiaries will obtain care under delivery models that hold participating organizations accountable for cost and quality measures. Each service-delivery model will include PROMs as part of its performance assessment, according to CMS.

Slow progress towards reliable outcomes reporting

Despite this progress, the widespread implementation of routine outcomes collection has been “limited,” according to a study in JAMA. In the study, about half of the eligible 205 clinics that researchers evaluated collected PROs at a rate greater than 50%.

The researchers who reported those results in JAMA chalked up that slow progress to clinician, staff and patient reluctance; inadequate resources to deal with positive or unexpected results; concerns for how patient data would be used; and workflow and technology challenges.

In fact, some of the best-intentioned outcomes collection efforts by healthcare organizations have foundered because of how they have been incorporated into work processes. Many healthcare organizations find themselves in arrangements with technology vendors in which PROMs collection is handled as an add-on to an existing electronic health records (EHR) system or specialty application. When approached in this manner, outcomes measures collection simply becomes a digitization of existing processes. Rather than completing a paper form at the doctor’s office, the patient fills out a digital form online.

This approach may work for patients who are dedicated to care-plan adherence. It doesn’t do nearly enough, though, to incentivize patients, who don’t receive anything valuable in return for the time spent completing the form. To patients, these forms often feel like busywork that does not lead to better engagement with their providers and health plans. This rudimentary approach to outcomes data collection makes it very difficult to customize patient-outcomes forms to obtain the kind of essential data, such as medication usage or the patient’s degree of pain, that could be used to redesign care processes.

As a result, healthcare organizations may miss opportunities to improve patient care, understand care gaps, and earn higher bonuses under value-based arrangements.

Better patient engagement with care management platforms

By contrast, a comprehensive care management platform can correct many of the deficiencies associated with collecting outcomes measures through EHRs. A thoughtfully designed platform can become a valuable companion to patients along the care journey, assisting with preoperative planning, virtual physical therapy classes and provider messaging.

A well-designed platform brings a higher likelihood of patient opt-in, in large part because patients are convinced of the value proposition of using it; namely, improving their own health with a physician-aligned tool that delivers important guidance throughout the care journey. Leading care management platforms leverage artificial intelligence and machine learning to adjust patients’ care paths in real time, enabling patients and physicians to respond quickly when changes are needed.

In this regard, the platform enhances patients’ trust as it helps them navigate the healthcare system’s hurdles. Patients come to view the care management tool as an essential part of their recovery processes, making them more eager to respond to requests for information.

To establish trust, care management systems must ask patients about their personal goals for recovery — and then visibly track their progress in reaching these objectives. When patients understand and visualize the concrete steps they need to achieve their goals — such as completing a 5k run or participating in their daughter’s wedding — they are much more likely to maintain the engagement and motivation required to achieve better health outcomes.

Similarly, thoughtfully designed care management systems combat request fatigue by parceling out notices for survey completion over time, in alignment with the patient’s care progression. Patients should be presented survey forms via a secure link delivered by text or email, based on their pre-stated preferences; they shouldn't have to log into the care management platform. Simplifying requests helps to drive sustained compliance.

Accurate, reliable PROs and PROMS hold the potential to help healthcare organizations enhance patient care and perform better in value-based arrangements, but traditional data collection methods are too likely to fail. By leveraging care management platforms, healthcare organizations can improve patient outreach and engagement to yield data that leads to new insights and better decisions.

Bronwyn Spira is a physical therapist and the Founder and CEO of Force Therapeutics.