Impact of patient-reported outcome measures on routine practice: a structured review. J Eval Clin Pract

Patient-reported Health Instruments Group, National Centre for Health Outcomes Development, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford, UK.
Journal of Evaluation in Clinical Practice (Impact Factor: 1.08). 11/2006; 12(5):559-68. DOI: 10.1111/j.1365-2753.2006.00650.x
Source: PubMed


Regular use of patient-reported outcome measures (PROMs) by health care providers in their routine practice may help to improve the quality of care, but more evidence is needed before routine use of PROMs can be recommended. A structured review was undertaken to examine whether and how regular use of PROMs might improve routine practice.
A systematic search of Medline accessed through Webspirs Silverplatter was undertaken for the years 1976-2004. Controlled trials in English evaluating the impact of clinical use of PROMs on routine practice were included. Data regarding study design, characteristics of PROMs feedback, patient populations and study results were extracted by three reviewers.
Feedback of PROMs results to health care providers appears to have a substantial impact on some processes of care, particularly on diagnosis of mental health conditions. However, the impact on patient health status is less consistent. Most of the published studies evaluated PROMs as a one-off screening technology and measured only provider behaviours and patient health outcomes.
The pattern of results suggests a general lack of clarity in the field, especially regarding appropriate goals for PROMs and the mechanisms by which they might achieve them. To fully evaluate their role in routine practice, studies need to use PROMs that capture issues of importance to patients and to measure impacts relating to the patient-provider relationship and patient contributions to their well-being. Until studies evaluate PROMs as a means facilitate patient-centred care, their full potential in clinical practice will remain unknown.

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    • "Department of Health and Human Services, 2006). PROs have been shown to improve the identification of conditions and health behaviors (Fredericksen et al., 2011), management of chronic conditions (Dobscha, Gerrity, & Ward, 2001; Marshall, Haywood, & Fitzpatrick, 2006), and patient–provider communication (Brown, Butow, Dunn, & Tattersall, 2001; Detmar, Muller, Schornagel, Wever, & Aaronson, 2002; Velikova et al., 2004). Meaningful and enduring PRO integration into care requires selection of PRO domains that are clinically relevant to providers, reflect patient priorities, or both. "
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    • "Feeding back the PRO information in a structured format to the clinician can promote patient-centered care by highlighting an individual's concerns [5]. Improvements in symptom or function monitoring, and patient– physician communication have been found [5] [6] [7]. On a systemic level, individual's PRO information may be collated and used within or across organizations to look at the impact of treatment on cohorts of patients and as a performance measure to assess quality of care [8]. "
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    • "A particular issue for the outcome of using measures is that patients may be unwilling to reveal some topics or may feel that PROMs do not capture their concerns and priorities . Furthermore, clinicians may not view problems identified using PROMs as warranting a change in practice or referral because they may be seen as either an inevitable side effect of treatment or, on the contrary, as not being caused by treatment or presenting problems (Greenhalgh 2009; Marshall et al. 2006). "
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