The Role of Outcomes in Patient-Centered Care

You already know that health care is about more than diagnosing and treating a disease or impairment—it’s about treating the whole person, because that person is more than his or her condition or symptoms. Fortunately, the rest of the healthcare community is finally catching on.

Modern health care puts the patient first.

As this Society of Critical Care Medicine (SCCM) article states, “Healthcare is no longer a disease-centric process. Modern healthcare is patient-centric, where patients (and their families) are active participants in care.” This perspective assumes that it’s the patient—and his or her family—who knows himself or herself best and that the best possible care outcome occurs when these individuals are actively involved in the process. According to the same article, this type of shared decision-making in health care has been linked with improved patient satisfaction levels and health outcomes.

This research report reveals that in 2001, “the Institute of Medicine [now called the National Academy of Medicine] called patient-centeredness one of six aims of a 21st-century health care system.” The report goes on to note that more recently, “the focus on patient-centeredness has shifted from rhetorical to real-world implementation,” which is due in part to the fact that the larger healthcare community is beginning to accept “measures such as patient experience and patient-reported outcomes as valuable in themselves, whatever their impact on cost and quality.” It’s also partly due to the fact that these “patient-centered measures are playing an increasingly important role in the health system’s historic transition ‘from volume to value.’” Even the Institute for Healthcare Improvement’s Triple Aim—which is the driving force behind that transition—included improving patients’ healthcare experiences as one of its top three objectives.

Patient-reported outcome measures show what matters to patients.

So what, exactly, are patient-reported outcome measures (PROMs)? This Commonwealth Fund article states that these types of measures are a “critical component of assessing whether clinicians are improving the health of patients.” They differ from both process measures, “which capture provider productivity and adherence to the standards of recommended care,” as well as patient experience measures, “which focus on aspects of care delivery such as communication.” That’s because “PROMs attempt to capture whether the services provided actually improved patients' health and sense of well-being [emphasis added].”

To complete patient-reported outcome measures, patients may be asked to answer questions regarding their:

• Overall health
• Pain and fatigue levels
• Ability to complete certain functional tasks
• Mood

According to the SCCM article, these measures—as well as patient experience ones—get at the “results of medical care that are important to patients.” In the Commonwealth article, Mary Barton, MD, MPP—who serves as the National Committee for Quality Assurance’s vice president for performance measurement—agrees, saying, patients appreciate this type of focus on functional outcomes: "These are things that matter to patients: Do I feel better? Can my mom go up the stairs after hip surgery?"

As I mentioned in this post, asking your patients questions about how they feel—and then showing that you’re acutely interested in learning the answers—is just good bedside manner. This can empower patients to take a more active role in their treatment and participate in shared decision-making.

PROMs are the future.

Up until recently, the use of patient-reported outcome measures in clinical care was still relatively rare, because most providers preferred relying on objective, clinical data to measure patient progress. However, times are clearly changing: in the same article, Kristine Martin Anderson, senior vice president at Booz Allen Hamilton, said, "I see patient-reported outcomes as creating a brand new feedback loop and really for the first time creating measures of quality out of the eyes of the patient—not the eyes of the doctor.”

Patient-reported outcome measures already are used effectively in healthcare systems across the country. Rachel Hess, MD, the assistant professor of medicine, epidemiology, and clinical and translational science at the University of Pittsburgh, believes this kind of data could improve the coordination of care across patients’ health care teams, saying that "as patients transition from primary care practice to different specialty practices for particular conditions, it would be helpful to have that same sort of standardized data across time, so that we know how the condition has evolved and responded to different treatments."

Having a broad reach is one of the selection criteria WebPT uses for the patient-reported outcome measurement tools included in our application. Our hand-picked library of evidence-based, industry-accepted tests are already familiar to—and respected within—the healthcare community at large. So, you could (in theory) compare your Oswestry Disability Index data with that of the Spine Center located at Dartmouth-Hitchcock Medical Center, because—according to the Commonwealth Fund article—the Spine Center has been collecting this type of outcomes data from patients since 1997. (Check out this post to learn more about the outcome measurement tools we’ve added so far.)

Are you collecting patient-reported outcome measures in your practice? Have you found doing so improves patient satisfaction and engagement levels? Tells us your experience in the comment section below.