Patient Reported Outcomes (PROs) have been an integral part of health delivery in Europe and elsewhere for years, and both patients and providers value this type of patient-driven communication and proactive healthcare participation. Despite the apparent value, the use of PROs in the United States is substantially less frequent than in Europe. When you compare the work load, EHR usage, staff support, care management teams, financial incentives, etc. between providers in Europe and in the United States, there are not dramatic differences, so, why has the use of PROs here in the United States been so far behind?
I believe that the primary reason PROs are so infrequently used in the United States is a fundamental lack of understanding about what PROs are and how they can be used for the benefit of both patients and providers. PROs are based on the answers to very specific questions that are relevant for a targeted group of patients. Patients complete short questionnaires using their home computer or an app on their phone, and the resultant PROs are viewed within the providers’ EHR.
The collection of PROs does not provide another way for patients to ask questions, obtain off-topic care, or generate a new workload and liability situation. For example, if a patient was just discharged after a total knee replacement, the questions patients will be asked to answer/complete their PROs will all be specific to that clinical circumstance. These questions may be about pain control, ability to ambulate, wound status, etc., but they will not allow the patient to add other comments that would require follow up. There are other ways to communicate these comments to the appropriate provider, which are unchanged.
Another reason I believe that PROs are not utilized more in the United States is providers concern that PROs will be another time sink with unclear value. After 20 years of practicing internal medicine, I am very familiar with the “one more thing” perspective and the many unproductive requests for providers’ time, however with the right type of PROs for the right patients, PROs can actually make providers more efficient and improve the quality of care they deliver. To better understand this, let’s look at some of the different types of PROs and how each can be of value:
Intake – Patients can complete questionnaires while in the waiting room or at home, which can streamline the gathering of information and the documentation process.
Post-procedure – Patients’ answers to questionnaires can help identify patients who aren’t doing well or may be developing a problem, so the issue can hopefully be addressed before it becomes significant.
Post-discharge – Patients’ responses can help providers and care teams ensure that patients recently discharged from the hospital are progressing as expected and reduce the risk of readmission.
Chronic disease management – PROs for patients with chronic illnesses, such as diabetes, congestive heart failure, etc. can help providers manage their patients between visits, know when a face-to-face evaluation may be needed, and decrease the risk of disease progression and hospitalization.
Pediatric – PROs for pediatric patients are based on age-appropriate questionnaires, which can help keep these patients and their parents engaged and the providers informed.
Shared Decision Making – PROs can help both patients and providers in selecting the best treatment options for the patients based on the patients desired health outcomes, by doing this the patient will be more engaged.
PROs can not only help both patients and providers with day-to-day care and management decisions, but providers can also use them to show that they deliver high quality care in areas that really matter for the patient. For example, if you can demonstrate that your patients had a lower incidence of urinary incontinence or erectile dysfunction after prostate surgery than average, you can enhance your reputation, the demand for your services, and likely the reimbursement for your work as well.
PROs have been used in Europe and elsewhere for years with great support by both patients and providers. As the health care system in the United States becomes more familiar with PROs and their benefits, hopefully we’ll see them used much more here as well.