HIMSS 2017: Patient-reported outcomes can boost value-based care—with the right design

Outcomes reported by the patient can bring actionable data to a provider and save money in the long run. Collecting that data, however, requires technology that patients can easily access and use.

Utilization of patient-reported outcomes (PROs) is moving beyond hospitals getting credit just for collecting them, as was the case in CMS’s Comprehensive Care for Joint Replacement (CJR) program. Laurence Higgins, MD, MBA, the chief of sports medicine at Brigham and Women’s Hospital in Boston, offered several examples of where PROs provided actionable data to improve outcomes and lower costs.

One instance was an examination of what follow-up visits for rotator cuff surgeries cost the hospital. By figuring out how to cut down on the use of personnel resources for visits with a minimal impact on post-operative outcomes, Higgins said the cost of an entire episode was slashed by 21 percent.

Collecting around 185 discreet outcome metrics per month creates data that can affect clinical decisions, Higgins said, by comparing one patient’s progress to the average post-operative track. In one case, a 59-year-old patient who was hurt while at work reported scores well below average six weeks after surgery. A call to the patient revealed his worker’s compensation request for physical therapy had been denied, leading to worsening pain and stiffness.

Using the PROs, Higgins said the hospital has able to get the worker’s comp request for physical therapy approved and his outcome data quickly improved.

“The data, for me, has to be actionable,” Higgins said, “and I think that’s the journey I’ve actually undergone is taking this important PRO data and using it to optimize patient care and optimize the value that we’re delivering.”

Collecting that data, however, presents some design challenges. Scott Bradley, MBA, vice president of product strategy at healthcare data company OM1, said one of the main barriers preventing that data from being put to good use are badly designed portals for patients.

Bradley recommended asking patients simple, straightforward questions about their progress through mobile applications. The ideal setup would be a survey where patients answered one question at a time, with all possible responses fitting on a single screen.

Providers will likely need a small design team to create the app, Bradley said, warning against simply copying a paper survey.

“We’ve already shifted to the electronic health records world,” Bradley said. “Why would we go back to a paper world for patient-reported outcomes?”