Getting the Most for Patients with Patient Reported Outcomes

Patient-reported outcomes can be simply defined as a report that shows or tells 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. So basically it is what the patient says is wrong or how they say the treatment makes them feel. The main goal of patient-reported outcomes is aimed at getting the most for patients. The logic behind it is if patients can accurately describe how they feel and how their pain or discomfort reacts to treatment and care providers can become more accurate, precise, and effective.

Physicians typically want to engage patients, but they don’t have much time to do so. According to a RAND study from 2013, 80 percent of doctors said they were dissatisfied with electronic health records because of increased documentation time and decreased patient engagement time. Doctors prefer when there is a higher patient engagement because it means there is more interaction between the car provider(the doctor) and the care recipient (the patient). This is another reason why clinical environments need to operate as efficiently as possible.

Patient portals sometimes present as a burden to physicians as it appears to introduce more work. Whereas, patient engagement is a more natural process that makes for a more overall wholesome experience for both doctors and patients. Good data, in some cases, solve this and drives a culture of quality. A culture of quality improvement goes a long way toward motivating physicians to engage their patients. All physicians want to deliver quality care to their patients. A data-driven environment keeps that quality in the physician’s mind at all times. Data focuses care, drives evidence-based decision making, and enables process and workflow improvement. It allows physicians to concentrate on the thing that matters most which are improving lives.

The topic of patient engagement is a widely researched topic in the healthcare industry that garners a lot of curiosity. This means that there are tools and innovations often brought to the market to help track or measure it. These instruments are largely referred to as Patient Reported Outcomes Instruments

Broadly, PRO instruments can be classified as per the measurement of the interesting concept as:

Generic

Which means it is anticipated to detain a very wide variety of aspects of health status and the outcomes of illness and hence to be applicable to a wide range of patient groups e.g. The Psychological General Well-Being Index (PGWBI)

Disease-specific: e.g. Rheumatoid Arthritis Quality of Life questionnaire (RAQoL)

Dimension-specific: e.g. Physical Activity Index (PAI)

Region/site specific: e.g. Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR)

Individualized

These are instruments in which the respondent is allowed to select issues, concerns or domains of personal concern that are not predetermined by the investigator’s list of questionnaire items e.g. Schedule for the Evaluation of Individual Quality of Life (SEIQoL)

Utility measures: Utility measures are usually considered as generic type but with one particular form of numerical evaluation of healthiness) e.g. Utility measure for major, unipolar depression (McSad)

Summary items: These includes things like questions regarding limiting enduring illness in General Household Survey

Now, all types of patient-reported outcomes (PROs) have their own advantages and disadvantages. When evaluating a patient-reported outcomes PRO instrument, the following things should be checked

  • Validity
  • Content validity
  • Construct validity
  • Criterion validity
  • Reliability
  • Test-retest or intra-interviewer reliability
  • Internal consistency
  • Inter-interviewer variability
  • Ability to detect change

If the instrument fits all or most of this criteria then you know you are on track. If it doesn’t fit any criteria or fits just one criterium then you have to reevaluate and possibly use another instrument.