Patient and family engagement is increasingly acknowledged as a key component of a comprehensive strategy to achieve a high, quality, affordable health system, according to the National Quality Forum (NQF). Emerging evidence affirms that patients who are engaged in their care experience better outcomes and choose less costly, but equally effective, interventions.
However, historically, patients themselves have been a largely untapped resource in assessing the quality of health care. Patients are an extremely valuable and, arguably, the authoritative source of information on outcomes beyond experience with care.
A systematic and validated way to hear from patients is to solicit information on patient reported outcomes (PROs). PROs are the changes in an individual’s physical and/or mental health status, including their ability to perform normal household functions and job duties, resulting from medical treatments or procedures. For example, what is the quality of life or pain level for a patient who recently recovered from total knee replacement? PROs are typically measured using a standardized patient survey instrument, which exist for asthma, depression, back pain and a variety of other conditions and procedures.
According to the Consumer-Purchaser Alliance, consumers and providers should care about PROs, because they:
- Measure what is important to patients – the effect of medical care on their overall quality of life and daily activities;
- Address many issues that providers should be discussing with their patients that ultimately will affect their clinical outcomes;
- Give consumers essential information for provider choice; and,
- Represent a key element of patient-centered care.
Minnesota is nation-leading in the development of high-value PRO measures, and MNCM has developed and implemented multiple. PRO measures will continue to be a focus of our measure development work in the future because we believe they provide meaningful information and immense value.
Developing Patient Reported Outcome Measures
Over the past 10 years, MNCM has developed, implemented and/or publicly reported more than 75 measures that are widely accepted and aligned across payers and providers while fine tuning our measure development process, including involving a wide variety of stakeholders, to make it as efficient as possible. Each stage of our process has been thoroughly tested and thoughtfully considers whether the measure in development will be:
- Evidence based
- An opportunity for improvement
PRO measures are an ideal way to measure function, pain and quality of life from the best source of the information: the patient. They are an increasingly sought-after, highly-utilized type of performance measurement. MNCM’s PRO measures include:
- Patient Experience of Care
- Depression Care
- Asthma Control
- Total Knee Replacement
- Low Back Surgery
MNCM collects patient-reported Race, Hispanic Ethnicity, Preferred Language and Country of Origin data that is used to segment and report a variety of quality measures. In addition, we’re currently developing a cancer care PRO measure focused on pain management during radiation and/or chemotherapy.
“We are extremely excited about this new area of development and particularly its significant positive impact on an area of care where measurement is completely lacking,” said Jim Chase, MNCM President. “Integrating patient-reported outcome tools into existing cancer care practices provides an opportunity to make that care more patient-centered and enhance communication between patients and providers.”
Public reporting of quality results improves patient care; our decade of doing so demonstrates that in areas like depression and asthma care.
MNCM has developed and implemented nine performance measures that are endorsed by NQF; seven of those are PRO measures. Measures that have been endorsed by NQF are considered the gold standard for health care measurement in the United States. The federal government and many private sector entities use NQF-endorsed measures in their programs due to the thoroughness and consensus process behind them.
Our suite of Depression Care PRO measures were the first to gain NQF endorsement:
- Depression Response – Six Months
- Depression Response – 12 Months
- Depression Remission – Six Months
- Depression Remission – 12 Months
- Depression – PHQ-9 Utilization
In July, MNCM’s Spinal Surgery – Lumbar Fusion functional status and Total Knee Replacement functional status became MNCM’s newest PRO measures endorsed by NQF. Functional status is the patient’s ability to complete activities of daily living such as sitting, walking, getting in/out of bed, etc.
While it can be challenging to develop and test reliable, relevant specifications that are endorsed by organizations such as NQF, our track record is a testament to the expertise we’ve developed in PRO measure development and testing.
Accelerating the improvement of health through measurement and public reporting requires foresight; as a result, MNCM is constantly looking ahead. We are focused on meaningful and impactful measures where gaps currently exist that will drive improvement – providing, validated, actionable information on the cost of care, patient quality of life after certain procedures and quality of more specialty services.