Applications in Evaluating Quality of Care
Patient-reported outcome (PRO) measures can be used to improve the quality of healthcare services and to track or report on the performance of healthcare providers and healthcare delivery organizations.
Healthcare quality is measured and reported in a variety of ways, using established and approved reporting measures. HealthMeasures PRO tools can be used as components of measures to evaluate quality of care. PRO-based performance measures are referred to as PRO-Performance Measures, or PRO-PMs.
Process and Outcome Measures
Healthcare quality reporting measures are typically divided into “process” and “outcome” measures.
- Process measures assess the extent to which a provider performs an activity that is typically associated with a good outcome. Examples of process measures are the proportion of providers conducting foot exams in diabetic patients, recommending or prescribing an indicated treatment for a given condition, or administering a PRO in clinical practice. Providers that score highly on process measures are likely to have better health outcomes than those that score poorly on process measures, but this assumption is not tested.
- Outcome measures of health care quality performance actually examine end results, or health outcomes. Some outcome performance measures are derived from patient report, such as the proportion of patients reporting a specified level of experience of care, level of self-reported depression, degree of physical function, pain, or sleep.
HealthMeasures as PRO-PMs
PROMIS® is currently being used and evaluated for use by organizations as PRO-PMs. For example, the PROMIS Global Health scale is included in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) model. Such use is likely to become more common as PROMIS and other PROs are increasingly integrated into electronic health records, registries, and routine practice workflow.
PROMIS Depression Measures in HEDIS
The National Committee for Quality Assurance (NCQA) has added PROMIS Depression to the Healthcare Effectiveness Data and Information Set (HEDIS) 2018 measure set. Specifically, PROMIS Depression measures for adolescents and adults can be used to screen for depression. Users report the percentage of patients age 12 and older who are screened for depression with a standardized tool, and if screened positive, receive follow-up care. For more information, download the HEDIS 2018 Volume 2 Measures for Electronic Clinical Data Systems. HEDIS measures are used by more than 90% of health plans to assess the quality of care.
RTI International has published a book titled Patient-Reported Outcomes in Performance Measurement for a discussion of the major methodological issues related to the selection, administration, and use of PROs for individual patients in clinical practice settings, including those aiming to integrate patient-reported outcomes into a quality improvement/performance measurement program.
The User’s Guide to Implementing Patient-Reported Outcomes Assessment in Clinical Practice, produced on behalf of the International Society for Quality of Life Research (ISOQOL), outlines the needed resources as well as advantages and disadvantages to different approaches to assessment.
To learn about PRO performance measures in oncology, see Basch E, Snyder C, McNiff K. Patient-reported outcome performance measures in oncology. Journal of Oncology Practice. 2014:10(3):209-211.