Patient-reported outcomes or PROs are health-related signs and symptoms reported directly by the patient experiencing them. This is in contrast to outcomes reported by a physician or nurse. PROs are a prime example of patient-centered care because they are dependent on the experience and values of the patient. The purpose of PROs is to track whether or not a given treatment or medication is actually improving a patient’s health.
PROs are typically collected from patients using validated screening tools, which ask either general questions or specific condition-related questions. For example, a general question may ask about energy levels while a question for a patient with lung disease could ask about shortness of breath. PROs do not typically include things like heart rate and blood pressure, but instead include symptoms such as pain, nausea, or fatigue. Based on PROs, a physician or other healthcare provider can adjust their plan of care to improve outcomes and provide patient-centered care.
With the growing push for value-based care and reimbursement, the potential value of PROs in clinical practice has been increasingly recognized. A recent study looked at how many health systems and physician practices have adopted PROs in the United States. They found that pain and depression were the most popular symptoms being tracked, with both being adopted by approximately half of practices surveyed.1 However, the study authors concluded that there is a lot of room for improvement in overall PRO usage around the country.
Other research has explored the best way to collect PROs from both the patient’s and clinician’s perspective. According to this research, the ideal collection method is a remote electronic health record (EHR)-integrated questionnaire containing one to five questions with the ability for the patient to enter notes, report triggers, and request a callback.2 Additionally, clinicians reported wanting an EHR dashboard with graphical depictions of PROs, as well as an inbox message summary prior to visits.2
The potential growth and application of PROs in modern healthcare is essentially limitless. Rigorous research studies have already shown that when PROs are shared with clinicians, and clinicians adapt care plans accordingly, there are significant improvements in health outcomes. A recent randomized-controlled trial at more than fifty clinical sites around the United States provides a great example. The trial enrolled patients with metastatic cancer and gave them internet-based or automated telephone-based surveys once a week on a day and time of their choosing for up to one year.3 The questions were based on the National Cancer Institute’s PRO-CTCAE tool for tracking symptoms related to cancer treatment. When a patient reported severe or worsening symptoms, it triggered an email to designated clinic staff as well as delivery of educational materials to the patient about their symptoms.3 Overall, 97.3% of patients were still enrolled at three months and 91.5% of weekly surveys were completed.3 After three months, the PRO group reported statistically significant improvements in quality of life, physical function, and symptom control compared to the control group.3 For example, in the PRO group, 16.1% more patients had symptom control benefits and 13.4% more patients had quality of life benefits.3
Other research studies have shown clinically significant benefits of PROs in diverse patient populations. A few populations where benefit has been shown are patients managing depression, patients managing symptoms of dementia, patients controlling diabetes and blood sugar levels, as well as patients who received a joint replacement.4,5,6 In some cases, screening questions can even be answered by a patient’s family caregiver, if the patient is unable to articulate their symptoms themselves. Clearly, the collection of PROs is an evidence-based and scalable intervention that many practices are yet to take advantage of to enhance their person-centered care.
CaringWire is a flexible digital solution that health systems and physician practices can use to deliver validated screening tools to specific patient populations using text, email, or automated telephone calls. The design and implementation of CaringWire’s PRO solution is based on best-practices proven and backed by global research. Below is a visual of just some of the domains of care and screening tools that CaringWire is capable of delivering.
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