PROMises, PROMises: Finally, Quality Care We Really Care About
By Thomas Tsang, MD and Faraz Ahmad, MD
Patient-centered care and patient engagement have become central to the vision of a high value health delivery system. The delivery system is evolving from a fee-for-service transactional payment model to a value-based purchasing model using outcome data and quality improvement and attainment. The Centers of Medicare and Medicaid Services (CMS) and private payers have spurred delivery redesign of networks that focuses on a set of clinical quality measures and patient care experiences along with efficiency measures.
However, the questions we ultimately really care are: “Did I get better? Am I healthier?” With the advent of Facebook, PatientsLikeMe® and Avado, consumers and patients are sharing their healthcare experiences openly with their support system and strangers with similar illnesses. Our delivery system has yet to leverage the power of patient/consumer reported data in feeding back to care deliverers in the quality improvement cycle.
Clinical quality measures have traditionally consisted of process or surrogate measures and centered on providers and hospitals. As we move toward a system based on value, the measurement system must shift as well. Part of this movement will be utilizing outcomes directly reported from patients and their caretakers and incorporating these outcomes into quality improvement initiatives and payment models. The widespread adoption of standardized and validated patient-reported outcomes measures (PROMs) would accelerate the development of a patient-centered health system. However, new standards; patient-friendly, digitally-enabled instruments; secure portals; and more research will be required to facilitate adoption.
Patient-Reported Outcome Measures Used In Limited Settings
Patient-Centered Care And Patient Engagement As National Priorities
The Institute of Medicine’s 2001 landmark report, “Crossing the Quality Chasm,” listed patient-centered care as one of its six aims. The Affordable Care Act reaffirmed the import of patient-centered care through a number of its provisions, including the piloting of patient-centered medical homes and the creation of the Patient-Centered Outcomes Research Institute. The National Quality Strategy enumerates “Ensuring that each person and family are engaged as partners in their care” as one of six priorities to help achieve the three aims of better care, better health, and lower costs.