This next generation of accountability will allow us to move from being provider- and payor-centered to becoming truly patient-centered, and will serve as a key reminder that patients are no longer passive participants.
—Gregg Meyer, MD, MSc, chief clinical officer and executive vice president for population health for the Dartmouth-Hitchcock Health System in Lebanon, N.H.
As healthcare quality reporting continues to evolve in this era of value-based purchasing (VBP), players on both the giving and receiving ends of performance incentives agree on the need to improve the accountability metrics with which providers are measured, ranked, rewarded, and penalized. Many of the measures currently in use—e.g., Centers for Medicare & Medicaid Services’ (CMS) core process measures and patient satisfaction ratings, the gross outcome metrics of mortality, infection, and readmission rates—are blunt instruments in need of refinement.
Entities such as the National Quality Forum (NQF), the American Medical Association’s Physician Consortium for Performance Improvement (PCPI), and the National Quality Measures Clearinghouse (NQMC) recognize the need to develop and endorse more timely, credible, and patient-centered outcome metrics. Largely missing from the current crop of outcome measure sets is a meaningful account of the patient’s perspective.
Enter patient-reported outcomes (PROs), defined as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.”1 PRO tools “measure what patients are able to do and how they feel by asking questions” (see “Types of Patient-Reported Outcomes [PROs],” p. 19).
If successfully adapted for public reporting on a wide scale, PROs could become the next evolutionary step in healthcare quality reporting, integrating health status and patient experience data into outcome metrics that truly matter to patients. They could enable a richer understanding of their clinical experiences and responses to therapy, and help providers target necessary improvements with greater precision.
“As a provider, I care about my patients not developing infections, getting the right medications, and not being readmitted. Patients, however, have a different set of priorities around issues like ‘How quickly will I be able to return to work? When will I be able to chase my grandkids around the yard? How much is this care going to cost me out of pocket?’” says healthcare quality expert Gregg Meyer, MD, MSc, chief clinical officer and executive vice president for population health for the Dartmouth-Hitchcock Health System in Lebanon, N.H. “This next generation of accountability will allow us to move from being provider- and payor-centered to becoming truly patient-centered, and will serve as a key reminder that patients are no longer passive participants. They are key partners, in both the delivery of care and the measurement of that care.”
The idea of PROs is one whose “time has finally arrived,” according to medical outcomes researcher David Cella, PhD, professor and chair of the Department of Medical Social Sciences at Northwestern University Feinberg School of Medicine in Chicago.
“The case for inclusion of outcomes that matter most to patients, like the effect of treatment upon their symptoms, function, and overall well-being, has always been compelling as an ideal to strive toward,” Cella adds. “PROs can and should be considered as true treatment outcome measures, and their ability to capture quality information efficiently make them well-suited for this role.”
The FDA even permits PROs (i.e. pain, anxiety, depression, sleep, and physical and social functioning) to be used as experimental endpoints for clinical trials to support claims in medical product labeling.2
The Patient Voice
The Department Health and Human Services (HHS) is searching for ways to fill current gaps in outcome measures, and has funded a patient outcomes project by the NQF to help ramp up patient-focused measure development activities within the federal government. In a recent report stemming from that project, the NQF states: “The patient’s voice is not readily captured in traditional health records and data systems, yet the beneficiary of healthcare services is often in the best position to evaluate the effectiveness of those services.”3