Why I Love Patient-Reported Outcome Measures

By Chuck Amos

I remember the moment I fell in love with patient-reported outcome measures, or PROMs.?

Some years ago, I was the quality leader at a safety-net clinic, and I knew little about PROMs or how they are used to collect information directly from patients about the outcomes that matter most to them. I did know, however, that we were doing an abysmal job of screening our patients for depression. We struggled to find a workable solution, until finally, one of our care teams got so frustrated that they volunteered to do a quality improvement project on administering the PHQ-9, a widely used PROM that helps clinicians screen for depression, make a diagnosis, and monitor change over time.??

Within the first couple of days, one of the care team members stopped by my office to tell me about a patient, a middle-aged man struggling with several health-related social needs. The doctor began talking with the patient about his PHQ-9 score, and the patient opened up about overwhelmingly sad feelings he had been dealing with all of his life. He knew something was wrong, but he’d never had a doctor ask him about it, and he didn’t know how to articulate what he felt or that it could be treated. After talking with him about it, the doctor connected the man with a licensed clinical social worker and began exploring medication regimens.??

Seeing how the care team and the PHQ-9 changed this patient’s life inspired my newfound love for PROMs. Since then, a significant part of my work has focused on elevating patients’ voices in clinical care and quality measurement.??

I love PROMs because they help us know whether we helped an athlete start running again, or helped a grandparent start playing with their grandkids, or helped a man begin managing an illness he’d carried the burden of his entire life. I love PROMs because they help change patients’ lives.??

Quality measurement in healthcare can be tricky. We are good at measuring whether we have prevented things a patient doesn’t want, like infections or hospital readmissions, but we’re not always good at measuring whether we accomplished what the patient wants. I love PROMs because they help us know whether we helped an athlete start running again, or helped a grandparent start playing with their grandkids, or helped a man begin managing an illness he’d carried the burden of his entire life. I love PROMs because they help change patients’ lives.??

I feel privileged to have convened some of the country’s foremost PROM leaders on two important NQF projects, one that helps clinicians choose and implement PROMs for their patients, and one that helps measure developers incorporate patient voices into quality measurement. I also feel privileged to be in a position where I can help people understand PROMs.??

Whenever I talk to healthcare professionals about PROMs, I usually hear something along the lines of, ‘I know they’re important but I don’t know how to use them,’ and often they admit to not fully understanding what PROMs are. Usually, I tell them that a PROM is basically a survey—albeit one with extensive scientific rigor behind it. I love to put it into those terms, because I almost always see a wall come down and a lightbulb go on when they start to understand that using PROMs isn’t as difficult as they may have thought.?

Of course, nothing in healthcare is easy. Using PROMs is fraught with challenges. They can be expensive and time-consuming, they can require new clinic workflows, and they can excite and inspire one group of clinicians while alienating or intimidating others. These challenges remind me of the years I spent working on electronic health record (EHR) systems, back before EHRs were widespread. I find solace in this comparison, because I see how healthcare has embraced the potential of EHRs and committed to overcoming their challenges. I find solace because I know we can do the same with PROMs.??

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