The growing demands for quality and safety in health care have refocused attention on patient centered outcomes (PCO). It will benefit all parties in the patient-provider-payer triangle. The expected patient-oriented outcomes is needed for involvement of patients in shared clinical decision making.

Providers can improve competitiveness by constantly monitoring and improving quality that matters to patients and can inform patients choice of provider. Payers can get an explicit knowledge about how commissioned healthcare services influence care on the patient level. PROMS is basis for a new way of incentivizing payment to providers for achieving specified, contracted outcome improvements reported by patients. This has been introduced in 2014 by Monitor in the NHS and is under consideration in Norway.

What´s being measured by PROMS

Patient Reported Outcome Measures (PROMs) are principally questionnaires, which measure different aspects of health and quality of life from the patient’s perspective. As of April 1, 2009, the NHS in England became the first system in the world to collect patient-reported outcomes measures routinely. Although PROMs will often correlate with objective test outcomes, PROMs offer insight into a patient’s status that are not easily measured with objective clinical tests or medical imaging (eg, PRO pain status). The differences in the answers before and after treatment allow a calculation to be made of the health gain a patient has achieved as a result of their treatment.

Condition-specific PROMs range from a short list of items focusing on one or two dimensions of health to multidimensional comprehensive questionnaires with several items within domains. An example is the Oxford Hip Score, which has 12 items concerning pain and functioning and is used in the current DH PROMs programme to evaluate hip surgery. They can be used in combination with a generic measure such as the EQ-5D to capture different aspects of health.

There are many multidimensional PROMs for specific conditions. Several reports of PROMs for specific health conditions can be downloaded (http://phi.uhce.ox.ac.uk).

PROMS should be a prioritized area for patients receiving surgical care of curative intent for cancer (Macfield, R.C.: Br..J.Surg. 2013,100, 28-37). 

Provider´s perspective on improved care by PROMS

With the growing competition in the healthcare industry, practitioners are under increasing pressure to prove the effectiveness of their treatments.

PROMS can provide healthcare professionals and administrators with additional information to evaluate healthcare services on an ongoing basis.

PROMs support clinicians to benchmark their performance, enabling them to provide the best care possible for patients.

Additional effort is required to support to clinicians who will respond to patient concerns and issues, with clear system guidelines in place to guide their responses. Such a training package has been created to enable oncology doctors to optimise their use of PROMs data within the consultation (Quality of Life Research;Jun2013, Vol. 22 Issue 5, p939).

Commissioners´s perspective on improved care by PROMS

PROMs support commissioners to judge the quality of care offered by different providers, guaranteeing consistency of treatment.

In England Best Tariff Payments introduced by Monitor in 2014 cover a limited but growing number of procedures for which providers are paid if they can reach required standards. Healthcare SouthEast is considering introducing a similar new payment system.

In coming years, PROMs are expected to play a more prominent role in assessing performance and determining the conparative effectiveness of different treatments because of a growing emphasis on value-based payment appraoches.

US  plans to incorporate PROMS into meaningful use standards.

What´s the evidence base for PROMS

The evidence-base for patient reported outcome measure (PROMS) instruments has progressed in the last decade spearheaded by the English NHS with US recently entering massively by the PCO Research Institute (PCORI) in 2011.

Recommendations for selected standards for the conduct of research leading to evidence-based, patient-centered health interventions has been reported (www.pcori.org). The report describes the rationale behind creating standards for patient centeredness, for prioritizing topics for research, for choosing a study design, and for designing, conducting, and reporting patient-centered outcomes research.

A recent review have quantified the outcomes which should form the basis for more reliable sample size calculation in the future (Cocks et al., 2011).