Types of Quality Measures

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.

PROs versus PRO-PMs

• A PRO (patient-reported outcome) is defined as any information on the status of a patient’s health obtained directly from patients, without modification by clinicians or other health care professionals. A short form quantifying level of depressive symptoms is a PRO. Sometimes PROM is used for patient-reported outcome measure.
• A PRO-PM (a PRO-based performance measure) is an aggregate of the patient-reported information in a reliable, valid measure of the quality of care delivered. For example, a PRO-PM could be the percentage of patients starting a new treatment for cancer that were screened for depressive symptoms.

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.

While both types of measures offer important insights, payers such as Centers for Medicare and Medicaid Services (CMS) and healthcare quality leaders such as the National Quality Forum (NQF) are advocating for more outcomes-focused measures. For example, the 2020 Analysis of Measurement Gap Areas and Measure Alignment from the Core Quality Measures Collaborative (CQMC) identified the need for PRO-PMs across multiple patient populations.