Simultaneously, a movement among patients and a number of organizations, such as the Society for Participatory Medicine and Institute for Patient- and Family-Centered Care, around these goals has flourished. In response to these currents in health care, hospital administrators across the country have launched of a number of initiatives targeting patient-centered care and patient engagement.
Additionally, the Affordable Care Act mandates the use of quality and patient care experiences as part of the qualification of health plans in the new State Insurance exchanges. The type of data and their uses are still to be determined during the ongoing insurance exchanges setup process. Undoubtedly, PROMs would be powerful and robust data to empower consumers in the selection of networks, plans or future ACOs.
Patient-Reported Outcome Measures Used In Limited Settings
PROMs, which measure a specific construct, such as health status, symptoms, functional status, or quality of life, have been developed over time and used in research and by payers. For example, in 2004 the National Institutes of Health created PROMIS (Patient Reported Outcomes Measurement Information System). Collaborative research across a number of centers led to the creation a series of brief, valid measurements of physical, mental, and social health.
The VR-12, which measures physical and mental health, has been used by the Veterans Health Administration, CMS, and the National Committee for Quality Assurance for quality assessment. Numerous disease specific measures exist as well. As David Lansky, Executive Director of Pacific Business Group on Health, points out, Sweden adopted PROMs for orthopedic procedures and has data collected from 90 percent of patients one year after their surgery. The Kansas City Cardiomyopathy Questionnaire measures health status for heart failure patients, and the Seattle angina questionnaire assesses those with coronary artery disease.
Despite the use of PROMs for research and quality assurance in select populations, adoption across larger populations have been limited by a number of factors, including complexity of instruments, resources necessary for administration, and a lack of recognized value by payers, providers, and patients. With the importance of patient-centered care, patient engagement, and PROMs becoming increasingly recognized, we recommend the following to encourage the adoption of PROMs: