Can patient reported outcome measures (PROMs) be both an indicator of care quality and a tool to manage individual patients?
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Speaker: Dr Joanne Greenhalgh, Associate Professor – School of Sociology and Social Policy, University of Leeds
This presentation will draw on findings from a realist synthesis of patient reported outcome measures (PROMs) feedback to discuss the tensions between using aggregated PROMS data as an organisational quality improvement strategy and individual PROMS data in the care of individual patients. Two synthesis were conducted to explore (1) feedback of aggregate PROMs data as an organisational quality improvement strategy; (2) feedback of PROMs data in the care of individual patients.
The review of the aggregate feedback of PROMs data found that the perceived underlying driver of the public reporting of performance and PROMs data played a significant role in providers’ engagement with and response to the programme. For example, providers perceived mandatory public reporting programmes initiated by regulators or national/state governments as being driven by ‘political motives’. In contrast, clinically led public reporting systems were perceived as being driven by a desire to improve the quality of patient care, which secured greater clinical involvement.
The review of individual PROMs data also found that unless the data collected supports clinicians in their care of individual patients, clinicians will either avoid using the PROMs or adapt their use in a way that may undermine their value for one or both purposes. For example, clinicians perceived that standardised PROMs constrained their relationship with patients and were difficult to incorporate into the flow of consultations. Clinicians avoided using them or adapted the PROM, which may compromise their validity. Individualised PROMs supported consultations by allowing patients to ‘tell their story’ but they were less useful as an outcome measure; their value lay in acting as a ‘conversation opener’ rather than a quantification of patients’ problems.
The review raised two important challenges. The first is whether it is possible to achieve consensus between different stakeholders on the goals of PROMs data collection such that these data lead to improvements in the quality of patient care. The second is whether the same PROM can be used for multiple purposes, as PROMs that clinicians find useful in assessment patients, such as individualised measures, may not be useful indicators of service quality.
Functionality and Feedback: a realist synthesis of the collation, interpretation and use of PROMs data to improve patient care was funded by National Institute for Health Research Health Services and Delivery Research Programme 12/136/31. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.