Several obstacles must be addressed to realize the full potential of Patient-Reported Outcome based Performance Measures (PRO-PMs) in evaluating the quality of care.
Disease-Targeted versus Universal Patient-Reported Outcomes (PROs)
More research on what PROs should be used in PRO-PMs is needed. Some PROs were developed for specific patient population (e.g., KOOS for knee osteoarthritis) and other measures were developed to be used across conditions (e.g., PROMIS Physical Function). Universal measures can minimize redundant assessment, facilitate comparisons, and avoid undue patient/provider burden but may not always include critical aspects of a symptom or function for a specific condition. Identifying what measures for what patients is an area of active research.
Process versus Outcome PRO-PMs
More research is needed to identify how to best utilize a PRO in a PRO-PM. When are process measures (e.g., percentage of patients with cancer screened for emotional distress) most appropriate and when are outcome measures (e.g., percentage of total knee replacement patients with physical function surpassing an identified threshold) most appropriate?
Many providers have called for risk adjustment strategies that will enable PRO-PMs to fairly evaluate providers who care for sicker patients or who deliver care in low-resource settings.
New Areas of PRO-PM Research
- Studies confirming the clinical relevance of PRO-PMs
- PRO-PMs as means of measuring patient engagement, patient activation, and the quality of shared decision-making