In this interview, Intermountain Healthcare Associate Vice President for Delivery System Science Lucy Savitz explains how using patient-reported measures can improve the patient-centeredness and value of health care.
How prevalent is the current use of patient-reported measures (PRMs) in the US?
Health care providers often overlook the best way to determine the success or failure of a clinical treatment or procedure: Ask the patient.
Although some clinicians in the US have been using PRMs for a long time, the use has often been limited to single practices and largely tied to episodes of care for selected procedures — most commonly in orthopedics, pain management, and physical therapy.
Even when programs and practices do collect PRMs, they do not always collect data in ways that support improvement, help them identify population management opportunities across the care continuum, or inform health policies. (The CMS-mandated Comprehensive Care for Joint Replacement demonstration project is an example of a program that requires inclusion of PRMs.)
It’s important to understand patients’ circumstances and preferences to achieve optimal outcomes, and using PRMs to get data directly from patients helps us do that. Ideally, caregivers would use the PRM insights to develop sensible treatment plans in collaboration with patients.
How does using patient-reported data help an organization evolve from a volume-based system to a patient-centered value system?
PRMs can give caregivers crucial information they might not otherwise learn, which in turn can help them deliver higher value care by better serving the needs of both the individual patient and the community.
One promising use of PRMs lies in aggregating the data, with the goal to use the collective results to inform optimal treatment planning for similar cohorts of patients. This allows providers to better predict which patients would benefit from targeted, comprehensive services that extend to community-based resources.
The same data can also assist in shared decision making — providers can use PRMs to help patients understand what to expect from different treatment options. For example, they can point to when or how similar patients have typically seen improvements in quality of life.
As a supplement to clinical data such as lab values and diagnosis codes, PRMs can provide insight into the patient’s circumstances and preferences. Through PRMs, caregivers might find out, for example, that a patient does not have adequate housing or food security. Assessing a patient’s social support is critical for planning a safe hospital discharge that avoids readmission or unnecessary emergency department visits.
Overall, collecting consistent PRMs in equal periodicity (e.g., every three months) helps to manage population health and monitor patterns in the data over time. Whether you are in an integrated delivery system treating a single patient across a continuum of care or conducting comparative analysis in a multi-center collaborative, consistently tracking the same measures will optimize their use in driving improvement.
What lessons have you learned from organizations that successfully gather PRM data?
- Integrate PRM data collection strategies with other planned patient contacts. For example, collect PRM data during post-discharge telephone calls.
- Harmonize measures so there are not different PRMs used in different clinical areas to capture the same type of information. (For example, PHQ-9, Zung, and PROMIS are all self-reported instruments that measure depression in different ways.) Using different and incompatible measures impedes the ability to track common values over time or to produce meaningful comparisons to drive quality improvement.
- Provide sufficient training to clinicians so they can readily interpret PRM scores and integrate them easily into clinical decision making.
In an interview with IHI's Kathy Luther on PRMs almost 1 1/2 years ago, she noted that there wasn’t yet a strong business case for using patient-reported measures. Is there more of a business case in 2016?
There is no solid research yet on the business case. However, we know that successful population management is key to moving from volume to value. PRMs serve a critical role in population management, particularly in reducing unnecessary care, and managing ambulatory-sensitive care that is ideally given outside a hospital setting. Getting good patient-reported data will help us get the right care to the right patient at the right time.
Lucy Savitz is Associate Vice President for Delivery System Science at Intermountain Healthcare and faculty for the Patient-Reported Measures: A Key to High-Value Health Systems Expedition, one of the benefits included in the Passport to IHI Training membership.
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