Connected Health: Patient-reported outcomes improve care

BOSTON--Current outcomes and measures—the way providers are compared—are a set of dull process measures that can’t articulate differences in providers, said Gary Gottlieb, MD, MBA, president and CEO of Partners HealthCare, speaking at the organization’s 10^th Annual Connected Health Symposium.

Patient-reported outcome measures (PROMs) are a path away from subjective material that can’t be compared or scaled, he said. “Part of our mission is to develop these tools. It’s critical to our strategy to use these tools to demonstrate that the way we work is better and has value.”

“We need a voice for our patients but it needs to be something that can be replicated,” Gottlieb said. That means tools that have construct validity and that the field accepts. “We want to use tools and measures that have been validated in specific areas and have credibility and can be replicated and scaled.”

Gottlieb discussed a typical patient the healthcare system is failing because even the “most magnificent providers” are working with incomplete data so they can’t provide the right care in the right place at the right time. “Ms. Lovell” has a history of treated endometrial cancer, morbid obesity and diabetes. A “frequent flier,” she is “seen by multiple specialists in a way that is not at all unusual,” he said. Her quality of life is quite poor, thinking about her pain before almost anything else. Ms. Lovell has not been able to lose weight, won’t check her blood sugar and generally doesn’t take care of herself.

“Unless the right questions are being asked, the EMR becomes a big, thick paper chart,” Gottlieb said. “It’s hard to seek connection among hundreds of encounters.” Although good doctors have been seeing this patient continuously, Ms. Lovell has never seen a psychiatrist, social worker or therapist and her depression and anxiety has never been mentioned in her chart.

The principle of PROMS, Gottlieb said, is to “figure out how to ask the right questions in order for patients to teach us how to give them the right care. We need answers to go to the right clinicians—send answers to the clinician best suited to respond.” After addressing her mental health, Ms. Lovell has gotten her diabetes under control, is considering bariatric surgery and otherwise taking better care of herself.

Another challenge is managing patients who are less likely to complain. That’s a problem when “symptoms are the trigger for life-saving surgery.” Through PROMs, Partners began a process of scoring several cardiac symptoms such as shortness of breath and chest pain. Scores of 0 or 1 are acceptable but 2 or higher is associated with aortic stenosis. “One starts to reach a cliff very rapidly and surgery is curative but only appropriate for patients with symptoms,” Gottlieb said. Gottlieb cited a stoic, male patient who was unlikely to complain about any discomfort. Through PROMs, he scored a 2 on several questions and four days later had surgery. The chest pain resolved, his functional status improved and his mood and social function improved concurrently.

As a result of PROMs, Gottlieb said 94 percent of Partners’ cardiac surgery patients are chest pain free at three months and 88 percent can exercise without chest pain at three months. “These are meaningful results for patients and clinicians.”

“Patient-reported outcome measures capture some of the outcomes most important to patients and gives patients a voice in how we deliver care,” said Gottlieb. “Innovation must not further stretch our providers; otherwise we will fail. Adding the patient’s voice to our clinical data through PROMs allows us to improve care through better monitoring, demonstrate where we are effectively providing care and learn from variation to determine best practices. At end of the day we are so much better. This is the real telemetry of the future.”