scholarly journals Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

2017 ◽  
Vol 5 (2) ◽  
pp. 1-280 ◽  
Author(s):  
Joanne Greenhalgh ◽  
Sonia Dalkin ◽  
Kate Gooding ◽  
Elizabeth Gibbons ◽  
Judy Wright ◽  
...  
Keyword(s):  
Patient Care ◽  
Outcome Measures ◽  
Improve Patient Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Performance Data ◽  
Patient Reported ◽  
Communication Practices ◽  
And Performance ◽  
Improve Patient

BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Using patient-reported outcome measurement to improve patient care

2017 ◽  
Vol 29 (6) ◽  
pp. 874-879 ◽  
Author(s):  
John Øvretveit ◽  
Lisa Zubkoff ◽  
Eugene C Nelson ◽  
Susan Frampton ◽  
Janne Lehmann Knudsen ◽  
...  
Keyword(s):  
Patient Care ◽  
Outcome Measurement ◽  
Improve Patient Care ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Improve Patient

scholarly journals Assessing Professional Students' Application of the International Classification of Functioning, Health, and Disability Model and Patient-Reported Outcome Measures During Patient Care

2021 ◽  
Vol 16 (4) ◽  
pp. 316-320
Author(s):  
Sara L. Nottingham
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
International Classification Of Functioning ◽  
Actual Patient ◽  
Patient Reported ◽  
Icf Model

Context The International Classification of Functioning, Health, and Disability (ICF) model and patient-reported outcome measures (PROMs) are concepts that must be addressed in professional education. Objective Describe a class assignment that allows students to integrate the concepts of the ICF model and PROMs into actual patient care. Background Adult learners, including professional athletic training students, thrive on learning experiences where they can apply concepts and integrate new knowledge with existing knowledge. In addition, existing research suggests that most athletic trainers are not integrating PROMs into their clinical practice; therefore, students are most likely not seeing the use of PROMs during clinical education. Faculty can facilitate the application of the ICF model and PROMs into patient care with a course-based assignment. Description The assignment requires students to use the ICF model as an assessment tool with an actual patient, which helps shape their therapeutic interventions. Students recorded baseline and follow-up PROMs with this patient over a time period of at least 3 weeks while documenting their interventions and the patient's change over time. Students addressed reflection prompts in the assignment by describing their successes and challenges, in addition to describing their future plans for integrating the ICF model and PROMs into their clinical practice. Clinical Advantage(s) Students described this assignment as beneficial because it helped them treat their patients more holistically. Students self-reported increased knowledge and confidence with using the ICF model and PROMs in their clinical practice. Students described a plan to integrate these concepts into their clinical practice in a limited fashion. Conclusion(s) Faculty may consider integrating an applied, patient-based assignment such as this to assess students' application of the ICF model and PROMs to an actual patient. This assignment can also be easily condensed or expanded to fit different courses, student background knowledge, and assessment of different curricular content standards.

scholarly journals From obligation to opportunity: future of patient-reported outcome measures at the Veterans Health Administration

2019 ◽  
Vol 9 (6) ◽  
pp. 1157-1162
Author(s):  
Theresa M Coles ◽  
Sarah M Wilson ◽  
Bo Kim ◽  
Jean C Beckham ◽  
Warren A Kinghorn
Keyword(s):  
Outcome Measures ◽  
Veterans Health Administration ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Clinical Encounter ◽  
Veterans Health ◽  
Health Administration ◽  
Improve Patient Satisfaction ◽  
Patient Reported ◽  
Improve Patient

When implemented systematically and longitudinally outside of the clinical encounter, patient-reported outcome measures may bolster the therapeutic alliance, enable new opportunities for clinician-patient communication, and improve patient satisfaction and clinical outcomes.

scholarly journals How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis

2017 ◽  
Vol 23 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Joanne Greenhalgh ◽  
Sonia Dalkin ◽  
Elizabeth Gibbons ◽  
Judy Wright ◽  
Jose Maria Valderas ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Outcome Data ◽  
Realist Synthesis ◽  
Performance Data ◽  
Patient Reported ◽  
Main Programme

Objectives Internationally, there has been considerable debate about the role of data in supporting quality improvement in health care. Our objective was to understand how, why and in what circumstances the feedback of aggregated patient-reported outcome measures data improved patient care. Methods We conducted a realist synthesis. We identified three main programme theories underlying the use of patient-reported outcome measures as a quality improvement strategy and expressed them as nine ‘if then’ propositions. We identified international evidence to test these propositions through searches of electronic databases and citation tracking, and supplemented our synthesis with evidence from similar forms of performance data. We synthesized this evidence through comparing the mechanisms and impact of patient-reported outcome measures and other performance data on quality improvement in different contexts. Results Three programme theories were identified: supporting patient choice, improving accountability and enabling providers to compare their performance with others. Relevant contextual factors were extent of public disclosure, use of financial incentives, perceived credibility of the data and the practicality of the results. Available evidence suggests that patients or their agents rarely use any published performance data when selecting a provider. The perceived motivation behind public reporting is an important determinant of how providers respond. When clinicians perceived that performance indicators were not credible but were incentivized to collect them, gaming or manipulation of data occurred. Outcome data do not provide information on the cause of poor care: providers needed to integrate and interpret patient-reported outcome measures and other outcome data in the context of other data. Lack of timeliness of performance data constrains their impact. Conclusions Although there is only limited research evidence to support some widely held theories of how aggregated patient-reported outcome measures data stimulate quality improvement, several lessons emerge from interventions sharing the same programme theories to help guide the increasing use of these measures.

Sign in / Sign up

Export Citation Format

Share Document