The Role of Patient-Reported Outcome Measures in Driving Quality Improvement Initiatives and Health System Enhancements

Patient-Reported Outcome Measures (PROMs) are surveys or questionnaires that patients fill out to share information about their health, symptoms, mental state, and how their illness affects their daily life. Unlike doctor tests or assessments, PROMs show exactly how the patient feels without a doctor’s interpretation. This helps doctors and healthcare workers understand how the patient does day-to-day, beyond medical test results.

PROMs have become more common because they give important data that supports care focused on the patient. For example, a patient who had surgery can report their pain, ability to move, and feelings over time. This helps doctors change treatment plans to better suit the patient’s needs.

The Importance of PROMs in Healthcare Quality and System Improvement

PROMs play several roles in healthcare, both in treating patients and managing healthcare systems.

• Supporting Individual Patient Care: PROMs give real-time information about a patient’s health, so doctors can give treatments that fit each person. This helps doctors make better decisions and check if treatments work.
• Informing Quality Improvement Efforts: When many patient PROMs are combined, hospitals and clinics can see patterns in care, measure how well treatments work, and find areas to improve. This data can be compared to other healthcare places to drive ongoing improvement.
• Meeting Payer and Regulatory Requirements: Insurance programs and government rules increasingly ask providers to prove the quality and value of care. PROMs act as measurable evidence, especially under value-based care rules from agencies like CMS.
• Supporting Population Health and Research: PROMs help public health studies by showing how treatments work for groups of patients. They support research about managing long-term diseases and health differences among groups.

A guide made from talking with 46 experts at 38 U.S. healthcare groups explains how PROMs should be collected and used. It says success comes from making PROM collection part of normal clinical work and matching data analysis with what users need. It also notes that technology alone cannot solve problems; people’s involvement and workflow changes matter a lot.

Key Challenges in Implementing PROMs

Even though PROMs are helpful, there are problems when trying to use them in daily medical work:

• Ensuring Complete and Timely Data Capture: Collecting PROMs at the right times, like before doctor visits or during check-ups, is important. Missing or partial data make PROMs less useful.
• Resistance to Change: Medical staff might find new data collection steps hard or worry it adds work. This can slow down using PROMs.
• Meeting Diverse Stakeholder Needs: Different groups (doctors, administrators, payers) want PROM data in different ways and report formats.
• Equity in Data Collection: Some patients, like older adults, people who speak different languages, or those without internet, may have trouble taking part. This can cause bias in the data.

To fix these issues, many healthcare groups use electronic PROM collection through websites that connect to electronic health records (EHRs). These systems give standard ways to check symptoms and improve data quality. They can also send automatic reminders to patients and make PROMs easier to access.

Driving Quality through Systematic PROM Use

One example is the McKesson partnership with The US Oncology Network. They created a measure based on Patient-Reported Outcomes called PRO-PM. This measure looks at health-related social needs like housing, food, transportation, and safety. By checking if these needs get better, cancer clinics can prove their care meets value-based standards under CMS’s Merit-based Incentive Payment System (MIPS).

This network cares for over 1.4 million cancer patients yearly, with more than 2,600 providers at 600 care sites. They use PROMs to show how social factors affect treatment success. They also recognize roles like social workers and patient helpers who record and assist with these needs.

This example shows that PROMs are important not just for medical results but also for social and behavioral health issues that impact care. Collecting patient data in real time helps provide better and fairer care.

Integration with National Quality Strategies

The CMS National Quality Strategy focuses on improving the safety and results of healthcare across the U.S. It uses a set of important quality measures applied across Medicare, Medicaid, and other programs.

PROMs fit well into this plan because they provide patient-centered data that help healthcare systems meet Meaningful Measures goals and value-based payment rules. The collection, reporting, and feedback of quality data by CMS encourage healthcare providers to use PROMs to support prevention, wellness, and chronic disease care.

The Role of AI and Workflow Automation in Enhancing PROMs Implementation

Using PROMs well requires more than just collecting patient answers. Healthcare workers need to manage data, study large amounts of information, and apply findings in clinical decisions quickly. Advances in artificial intelligence (AI) and automation help a lot.

• Automated Call Systems and Front-Office Phone Automation: Companies like Simbo AI offer AI-based phone systems for medical offices. They remind patients and help them complete PROMs by phone or mobile. This cuts the work for staff and helps reach patients less likely to use web tools.
• AI-Driven Data Analytics: After data is gathered, AI tools can analyze feedback, point out urgent problems, symptom patterns, or care gaps. This helps doctors make fast, evidence-based decisions and helps managers watch quality metrics across patients.
• Workflow Integration and Task Automation: AI can automate tasks like scheduling PROMs, sending reminders, scoring questionnaires, and making reports. This makes PROM processes easier and builds them into daily work, ensuring data is complete and on time.
• Enhancing Patient Engagement and Equity: AI uses different ways like phone calls, text messages, and emails to reach patients. It supports different languages, accessibility needs, and custom reminders to consistently connect with hard-to-reach patients.

Practical Implications for Medical Practice Administrators, Owners, and IT Managers

Healthcare leaders and IT staff need to know the many roles of PROMs and plan how to add them into their systems. Here are important points to consider:

• Strategic Implementation Planning: Look at clinic workflows to find the best times and ways to collect PROMs. Linking PROMs to EHRs and front desk work stops workflow problems.
• Technology Selection: Choose platforms that support web and phone PROM collection, include AI automation, and offer simple data dashboards.
• Staff Training and Engagement: Involve doctors, social workers, and patient helpers to make sure PROM collection matches their work and helps patient care.
• Monitoring and Feedback: Regularly review PROM data to find ways to improve quality and meet payer reporting needs like those under MIPS.
• Addressing Equity and Access: Use tech like AI phone systems to reach patients who struggle with electronic surveys and reduce bias in participation.
• Aligning with National Quality Initiatives: Make sure PROM efforts support CMS’s National Quality Strategy and meet standard quality measures. This helps with getting paid and avoiding penalties.

Summary of Trends and Future Directions

The use of PROMs is growing fast in U.S. healthcare. CMS and other payers want more quality data based on patient views. Web tools and EHRs make collecting PROMs more standard, but full use depends on supporting workflows and technology.

Groups working together, like the OECD’s PaRIS project and McKesson’s oncology network, show how PROMs help both global and local efforts to improve care and value.

AI and automation from companies such as Simbo AI help solve problems like getting patients involved, making sure data is complete, and reducing work for staff. Future work will likely focus on better analytic tools and connected health platforms that give advice to doctors and managers in real time.

Healthcare leaders, including clinic administrators, owners, and IT managers, should recognize why PROMs matter and plan technology use carefully to get the most from patient data for improving care and health systems.

Through PROMs, healthcare systems hear the patient’s voice directly and can improve how care is given and its results. Adding PROMs to everyday clinical work, with the help of AI and automation, offers a practical way to better and fairer healthcare for all people in the United States.