Patient-Reported Outcomes

Patient-reported outcome (PRO) data keeps patient inclusion at the heart of any medical practice, procedure, clinical trial or service. While data sets such as length of stay (LOS), readmission rates and mortality rates are certainly statistics to analyze in the path to better care, PROs turn otherwise intangible aspects of the patient experience into concrete figures. The voice of the patient is a necessary component to improving care and outcomes.

This article aims to define patient-reported outcomes and demonstrate their value.

What Are PROs and PROMs?

Patient-reported outcomes are a broad category of results that come from patients themselves. Patient-reported outcome measurements (PROMs) are standardized, validated questionnaires that give providers information on a patient’s level of function, their overall health and how they are progressing after a surgery. PROMs are collected from patients around the time a medical intervention is planned. They are often administered at specific intervals prior to and after an intervention.

PROs provide concrete data for clinics and hospitals to analyze patients’ pain, function, and quality of life over the course of prescribed treatments and care plans.

Why PROs Are the New Gold Standard for Healthcare

PROs serve as a direct look into patients’ lives and well being. This is central to value-based healthcare and the reason more physicians are looking to PROs to administer, enhance and understand the outcomes of medical treatments. What sets PROs apart as the new gold standard?

First, PROs are the only way to truly understand a patient’s level of function and quality of life and provide treatment that provides meaningful value to the patient. Clinically, a treatment may be successful, but for economic, physiological or psychological reasons, patients’ conditions may not improve. An essential part of value-based healthcare includes taking the time to understand patients’ outcomes.

Secondly, more and more patient-reported outcome questionnaires are being heralded by healthcare regulators as clinically and statistically significant. Take, for instance, the Kansas City Cardiomyopathy Questionnaire, a 12-item PROM questionnaire used to measure patients’ perception of how heart failure has influenced their physical, social and emotional well-being. It is now qualified by the FDA Center for Devices and Radiological Health as clinically meaningful, not just anecdotally interesting.

Third, PROs allow patients to be more involved in their care. Physicians are using PRO data to have personalized discussions with their patients about how certain interventions could improve their health.

For medical professionals everywhere, PROs are becoming more standardized, more useful and, most importantly, better predictors of health status before and after treatment.

The Importance of PROs in Healthcare

Cost & Value

PROs are a vital data point in assessing the value, in terms of cost, that a treatment provides. As clinics and hospitals continue to face cutting reimbursement and higher costs, it is important to efficiently identify interventions that provide good outcomes and are cost-effective. There are many different procedures at different price points that are used in surgery. When considering physical function post-operation, the three common ways of doing a hip reconstruction are associated with very different costs. PRO data shows that the most expensive surgery actually resulted in the lowest PROMIS physical function scores. So, more costly procedures do not always lead to better outcomes. PROs help to demonstrate the value of certain treatments to healthcare systems.

Informed Decision-Making for Patients

PROs are a great way to help patients make informed decisions. Being transparent and educating patients on PROs can serve as a helpful tool by giving them insight into the experiences of other patients. It also helps with managing post-surgery expectations and supports patients in deciding if a particular surgery is right for them.

Impact on Providers

PROs can even be beneficial from the standpoint of office flow. Using PRO data, informing patients of what their outcome will most likely be at different intervals after surgery can mitigate calls to the office and unnecessary appointments. This is important to consider when asking overwhelmed health systems to collect PROs. However, positive feedback from PROs can be very rewarding for both providers and patients. An increasing amount of contracts and bundles are also including PRO data to reward top performers who show better outcomes against their peers.

Obstacles to PRO Adoption

Despite these positives, there is still some resistance to adopting PROs as a measure of outcomes. Doctors, clinicians and physicians:

• See paper-based methods of collecting and analyzing PROs as time-intensive
• Find that collecting PROs interrupts the flow of their daily duties
• Lack the technology to efficiently gather, store and analyze PROs
• Struggle to find ways to integrate the data into the day-to-day clinic life

Unfortunately, these qualms may be a reality for many medical practices. However, the quickly approaching future of PROs outweighs these barriers to adoption.

The Future of PROs

Recent evolutions in patient-reported outcomes paint a clear picture of the future of PROs.

First, as mentioned above, the future of PROs is qualified and regulated. As more PROM questionnaires go under review by regulatory agencies like the FDA, more will be proven reliable and valid both statistically and clinically. For medical professionals, that means there will be more thorough PROM questionnaires available. Secondly, these PRO questionnaires are more digitally integrated into reporting systems. Like the shift from paper to digital patient record-keeping, this may be a slow process, but as it becomes the norm, PRO data collection and analysis will no longer interrupt the flow of a clinician’s healthcare routine. That raises a towering question, though — who will collect, score and report on patient-reported outcomes? Will clinicians and staff be responsible? Generally, there are three options to consider when you decide to collect PROs:

• In house Programs: This involves use of your FTEs to collect, store, and report PRO data. FTEs will need to enter data into a usable format like Excel.
• Software as a Service (SaaS): Software that your staff uses to help facilitate the collection and reporting of PRO data. The system will also be dependent on your FTEs  to work and provide reporting
• Full Service PRO Program: Outsource the entire process of collecting the data to a 3rd party and no FTEs are needed.

Those who invest in robust PRO collection and reporting infrastructure will have a significant advantage over their peers opting for less sophisticated ways of collecting.

CODE Technology: The Vanguard for the Future of PROs

CODE Technology provides a full-service PRO program. At CODE, we work with clients to establish goals and create patient-reported outcome reports with those goals in mind. After tailoring a system to fit your needs, we connect with patients directly ourselves. All of this takes place outside of your clinic so there is no disruption to your clinic flow.

Through this dedicated, customizable system, we’ve generated an 80% capture rate across all intervals. As more PRO questionnaires become validated and available, we can only improve that process for the advancement of medical communities and their patients. Contact us today to find out how we can work together for a healthier future through robust, informative patient-reported outcomes.

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