PROMs: Bringing the Voice of the Patient into the Equation

The pressure to hold down healthcare costs, maximize clinical quality and improve patient experience has stimulated new approaches to measuring value, and places greater focus on the use of patient-reported outcome measures (PROMs).

PROMs offer a quantitative way for patients to communicate with providers about things that may matter more to patients than traditional clinical measures of outcomes, including pain levels, functions around activities of daily living, symptoms and quality of life. These patient-generated health data provide meaningful insight into outcomes, experiences, and engagement from the patient perspective.

“PROMs are precisely the missing link in defining a good outcome. They capture quality-of-life issues that are the very reason that most patients seek care: to address a bothersome symptom, limited function or ailing mental health,” state the authors of an article about the powerful role of PROMs in a recent NEJM Catalyst piece. “By making PROMs an integral part of clinical care, providers can use them to improve an individual patient’s care, as well as in aggregate to improve care of a population.”

Physicians also are increasingly paying attention to PROMs for their roles in determining reimbursement in several federal healthcare quality programs, including the Merit-Based Incentive Payment System and bundled payment initiatives. Those who embrace PROMs collection now will be ready for both federal and commercial payer initiatives.

Sluggish PROMs adoption

Despite the promise of PROMs and the growing emphasis on patient-centered care and value-based reimbursement, adoption has been slow among health systems. Just 20% of hospitals routinely utilize outcomes data provided by the patients themselves as a way to gauge the effectiveness and quality of care, according to a 2016 survey from Health Catalyst.

Respondents who did not integrate PROMs into their workflow cited financial concerns, health IT optimization barriers, organizational resistance and usability issues as some of their top challenges.

Traditionally, PROMs questionnaires were paper and pencil forms completed by patients and returned via postal mail, or completed at the time of a return visit. Not surprisingly, the response rates for paper-based surveys has typically been low. In addition, manually collecting and transcribing handwritten data is cumbersome and time-consuming for staff.

Now that computers, smartphones, and tablets are ubiquitous, electronic PROMs solutions have become increasingly popular. Electronically captured PROMs are more efficient, less costly and more user-friendly. However, even an electronic platform must integrate seamlessly into a provider’s existing workflow and be convenient for patients to use. Tolerance among providers and patients for technical glitches is understandably low. 

In addition to technological barriers, collecting and using PROMs can feel like one more task placed on already overburdened clinicians. Patients can feel equally burdened with administrative requests, between filling out health histories, signing consent forms and providing insurance information.

Providing value for patients and physicians

Many of our customers turn to GetWell Loop’s patient engagement solution because they’ve had difficulty achieving the minimum PROMs data collection rate needed to maximize reimbursement. Others may have been successfully collecting relatively high percentages of PROMs, but only through very time- and labor-intensive processes for staff, involving repeated phone calls and in-office reminders to patients.

Health systems and providers need a system that enables the effortless collection of data to make better decisions, achieve better outcomes and report quality measures effortlessly. The platform should automate the data collection process end-to-end, enrolling patients and managing data collection automatically, with minimal staff involvement. It should also integrate with the health system’s EHR with minimal disruption to the normal clinical workflow. And, perhaps most important, the solution should be frictionless and convenient for patients.

On average, our customers achieve an 82% PROMs response rate at baseline and 73% at 12 months post-procedure/post-visit with no effort from the staff to collect the data. The 12-month completion rate is particularly remarkable given that most of GetWell Loop’s care plans run for only a few months post-visit. This means that while the patient’s day-to-day check-in experience with his or her provider on GetWell Loop has concluded anywhere from 8-10 months ago, when the 1-year PROM notification comes to them, 73% of patients respond.

Our clients have also achieved success with PROMs data collection when administering questionnaires at more frequent intervals. In a recent multi-center study presented at the World Conference on Interventional Oncology, HealthLoop (now GetWell Loop) and BTG International in conjunction with clinicians at Northwestern University, Mount Sinai Medical Center, University of Louisville, and Vascular and Interventional Professionals evaluated the effectiveness of HealthLoop to educate, engage, and measure health-related quality of life in 41 patients with liver cancer undergoing treatment with BTG’s TheraSphere transarterial radioembolization therapy. The study demonstrated that patients were extremely willing to engage with the platform, providing PROMs responses at multiple survey intervals separated by only 2 weeks in time. The overall PROMs response rate was 71%.

Why are patients so willing to provide data about their quality of life when they’ve had no regular contact with their doctor via GetWell Loop for several months? Because before and after their face-to-face episodes of care, patients are engaged daily by their care teams in an ongoing and contextual digital dialogue. When a patient receive a notification from his or her provider to complete a PROM questionnaire, the message is coming from the physician — someone they know and trust — as opposed to a third-party service or a staffed phone bank. That automated communication leads to satisfied and loyal patients — patients who have received value and in return are willing to give back.

PROMs: A vital component of value-based care

Collecting PROMs in a consistent manner isn’t easy. It requires buy-in from healthcare leadership, physicians and staff, and a tool that doesn’t place additional administrative burden on them. It also requires tools that meet patients where they are, and engages them in a way that first provides value to them before soliciting them for something that provides value back to the practice.

Despite the challenges, the advantages of collecting PROMs are many. Patient-generated health data support quality improvement and optimal reimbursement for clinicians. Making use of patient-generated health data may also provide competitive advantages to providers, and hospitals, enabling them to demonstrate that their patients are receiving high-quality care. 

As the focus on lowering healthcare costs while improving quality and patient experience expands, the collection of PROMs will be an increasingly important part of determining the value in value-based care.