Course 1A: Introduction to Value-Based Health Care (Modules 1-3) > 4. Patient Outcomes.

4. Patient Outcomes.

MODULE 2 | Section 4 of 8

Patient Outcomes

PROMs

Now that we have explored the importance and impact of asking, “What matters to you?” let’s delve into strategies for measuring patient-reported outcomes that address the question of “How are you?” One way to ensure that we improve patient outcomes is to ask our patients about their priorities and states of being. An important subset of outcomes are patient-reported outcome measures, sometimes referred to as “PROMs” or “PRMs.” PROMs attempt to capture whether the services provided actually improved a patient’s health and sense of well-being from the perspective of the patient. For example, patients might be asked to assess their general health, ability to complete various activities (dress themselves, read, climb a flight of stairs, go to work, etc), mood, level of fatigue, and pain.
Watch the video to learn more about the benefits of PROMs.

RESOURCES FOR MEASURING PATIENT OUTCOMES

The International Consortium of Health Outcomes Measurement (ICHOM)

A common concern is how to identify a reasonably small set of validated measures to use for improvement efforts and against which to benchmark.

The International Consortium of Health Outcomes Measurement (ICHOM) is a not-for-profit organization founded by The Institute for Strategy and Competitiveness at the Harvard Business School, the Boston Consulting Group, and the Karolinska Institute to accelerate use of patient outcome measurement in health care. ICHOM convenes an international panel of patients and physicians to develop standard patient outcome measurement sets from previously validated instruments across the spectrum of patient conditions.1 This collaborative process allows for the identification of measure sets that can be used for improvement efforts and for benchmarking without getting lost in too many potential measures.

ICHOM aims to create “Standard Sets” of outcome measurement for over 50% of the global disease burden by 2017. As of October 2016, they had completed 20 Standard Sets, which they calculate to account for approximately 47% of the global disease burden.2

For example, consider heart disease, from which Ms. Jones has recently been suffering.

“The ICHOM Standard Set for Coronary Artery Disease is the result of hard work by a group of leading physicians, measurement experts and patients. It is [their] recommendation of the outcomes that matter most to persons diagnosed with Coronary Artery Disease.”3

  1. Includes occurrence of strokes, acute renal failure, prolonged ventilation, deep sternal wound infection, and other causes of reoperations.
  2. Includes occurrence of strokes, acute renal failure, significant dissection, perforation, vascular complications requiring intervention, bleeding event within 72 hours, and emergent CABG for failed PCI.
  3. Tracked via the Seattle Angina Questionnaire (SAQ-7)
  4. Tracked via the Rose Dyspnea Scale
  5. Tracked via the Patient Health Questionnaire (PHQ-2)

     

    © 2015 ICHOM. http://www.ichom.org/medical-conditions/coronary-artery-disease/

CHALLENGES

PROMs and other types of patient experience data are not easy to obtain. The need to collect and track individual patient data can be burdensome and time consuming, requiring much longer periods of contact post-treatment. Including PROMs in clinical workflow, perhaps through integration into electronic health record (EHR) systems, will be key to making them pragmatic and promote widespread use.
An additional challenge will be creating PROMs that are meaningful for all of the conditions that we as clinicians treat, and interpreting PROMs in the context of the multiple simultaneous conditions that so many of our patients have. The coming sections will discuss the steps being taken to meet this challenge.

Learn More

ARTICLE

Integrating Patient-Reported Outcomes into Orthopedic Clinical Practice: Proof of Concept from FORCE-TJR

Read more about the work being done to develop and research PROMs for patients undergoing total joint replacement (TJR). The federally funded FORCE-TJR Project, led by Dr. David Ayers from the University of Massachusetts, is prospectively tracking PRMs for 30,000 patients who have undergone joint replacement surgery over the course of several years.

Ayers, DC, Zheng, H, Franklin, PD
Clinical Orthopaedics and Related Research.
2013;471:3419-3425.

ARTICLE

Patient-Reported Outcomes—Harnessing Patients’ Voices to Improve Clinical Care

Dr. Ethan Basch describes the barriers and benefits of PROMs that can be electronically reported by patients and directly fed into Electronic Health Records (EHRs) for better management of patient vitals and issues like pain management and post-surgical recovery.

Basch, E
New England Journal of Medicine
2017;376;2:105-108

PDF

Implementing ICHOM’s Standard Sets of Outcomes: Cleft Lip and Palate at Erasmus University Medical Centre in the Netherlands

Read about implementation of ICHOM’s Standard Sets of Outcomes through a case study conducted on cleft lip and palate in the Netherlands. They compile their study, data, and key lessons learned in their research.
Arora J, Haj M. London, UK International Consortium for Health Outcomes Measurement (ICHOM) December 2016.

REFERENCES

MANUSCRIPT

 

  1. 1- ICHOM – International Consortium for Health Outcomes Measurement. ICHOM website. http://www.ichom.org/. Accessed December 4, 2016.
  2.  
  3. 2- Our standard sets. ICHOM website. http://www.ichom.org/medical-conditions/. Accessed December 4, 2016.
  4.  
  5. 3- Coronary artery disease. ICHOM website. http://www.ichom.org/medical-conditions/coronary-artery-disease/. Accessed December 4, 2016.
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ANIMATION

 

  1. 1- Teisberg E, Wallace S. Capability, Comfort and Calm: Designing Health Care Services for Excellence and Empathy [presentation]. Cleveland, OH: Patient Experience, Empathy Innovation Summit, May 16, 2016.
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  3.  
  4. 2- Lavallee DC, Chenok KE, Love RM… Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff. 2016. 35:575-582. doi:10.1377/hlthaff.2015.1362.
  5.  
  6. 3- Lazar K. Timing knee and hip replacements. Boston Globe. June 30, 2014. https://www.bostonglobe.com/lifestyle/health-wellness/2014/06/29/knee-and-hip-surgery-registries-yield-clues-for-more-successful-treatments/Fd48ealbP1QZHckhLMhY9L/story.html. Accessed December 11, 2016.

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