Patient Reported Outcomes: The Missing Link for Value-Based Care

Doctors and other health care providers take many types of measurements – between vital signs, screenings, lab tests, and x-rays, it can seem like things are constantly being measured. However, there’s one significant measurement that is often missing from the picture: the patient reported outcome. Hiding in plain sight, this is information that can only come from the patient. While generally gathered in an informal sense, patient reported outcomes are often not collected in any consistent, formal way. This missing link is not only unfortunate; it can also lead to poor quality, inappropriate treatment, and unclear outcomes.

As we move toward paying for value, patient reported outcomes are a very important factor to make sure that what the patient wants, whether that means returning to work, walking upstairs without needing to rest, or attending a daughter’s graduation, is happening.

On the bright side, researchers have developed useful tools for making better use of information provided by patients. These effective tools are finding their way into routine patient care and have been shown to increase the chance that patients receive appropriate procedures and that the outcomes of the procedures are good. As a result, we are seeing improvements in identifying patients who will get the most benefit from treatment, and in some cases seeing differences in outcomes of care provided by different hospitals or doctor groups.

We have recommended using standardized patient reported outcome survey tools in multiple topics. One example is in total hip and knee replacement. We include the measurement of functional status, using the Patient Reported Outcomes Measurement Information System (PROMIS), the Hip Disability and Osteoarthritis Outcome Score (HOOS) for hip joint replacement, and the Knee Injury, and Osteoarthritis Outcome Score (KOOS) for knee replacement. Examples of what these tools measure include:

• – frequency of knee/hip pain,
• – how much pain exists when going up or down stairs, and
• – how much pain exists when getting in/out of a car.

Collecting patient reported items such as these before surgery helps increase the likelihood that only patients who will benefit from surgery will receive it – while other patients might get the same benefit from an alternative therapy and avoid the risks associated with surgery.  Furthermore, follow up surveys help provide clear evidence that improvements, such as reduction in pain and improved function, actually occur.

The advantage is clear: the availability of this information not only benefits patients, but also payers, providers, and hospitals who can show with data that their patients are receiving appropriate care and are benefiting from it.

All of this requires healthcare providers to go beyond tracking routine billing and medical information to include patient reported outcomes and evaluations. In many cases, standardized tools and surveys have evolved to meet specific needs, such as the HOOS and KOOS surveys.  Other surveys focus more broadly on topics such as the patient’s experience during hospitalizations.  To be most effective, this information must be collected routinely and then be incorporated into electronic medical records.

We have also included patient reported outcomes in our recommendations for spine surgery, low back pain, coronary artery bypass graft surgery, and bariatric surgery.

As health care costs continue to rise, while quality and care outcomes remain variable, patient reported health status and outcomes of care will be an increasingly important part of determining the value in value-based health care.

Paul Gruen, MHA
Implementation Consultant, Bree Collaborative

Emily Wittenhagen
Program Assistant, Bree Collaborative