SPOTLIGHT: PATIENT CENTRED CARE Patient reported outcome measures in practice Scores of tools to measure outcomes that matter to patients have been developed over the past 30 years but few are used routinely at the point of care. Nelson and colleagues describe examples where they are used in primary and secondary care and argue for their wider uptake to improve quality of care Eugene C Nelson professor 12 , Elena Eftimovska researcher 3 , Cristin Lind patient advocate 4 , Andreas Hager patient advocate 56 , John H Wasson professor 1 , Staffan Lindblad professor 37 1 Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, 35 Centerra Parkway, Suite 300, Lebanon, NH 03766, USA; 2 Dartmouth-Hitchcock Health, Lebanon, NH, USA ; 3 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden ; 4 Rare Diseases Sweden, Stockholm, Sweden ; 5 Genia, Stockholm, Sweden ; 6 Hansen Law, Stockholm, Sweden ; 7 Quality Register Centre, Stockholm, Sweden Clinicians’ understanding of the effect of disease and treatment on patients’ daily lives is poor. 1 In response to this problem, over the past three decades, hundreds of standardised measures have been developed to capture patient reported outcomes, including symptom status, physical function, mental health, social function, and wellbeing. However, the patient reported outcome measures (PROMs) movement has largely been driven by the agenda of researchers or service payers and has failed to focus effectively on improving the quality of care from the patient’s perspective (box 1). We use two examples to show how the use of PROMs in everyday practice has the potential to narrow the gap between the clinician’s and patient’s view of clinical reality and help tailor treatment plans to meet the patient’s preferences and needs. 2 Barriers to routine use Evidence shows that the systematic use of information from PROMs leads to better communication and decision making between doctors and patients and improves patient satisfaction with care. 3-7 There is also evidence that patients report better outcomes—for example, improvement in depression. 8 However, research on attempts to embed measurement of patient reported outcomes into routine practice has revealed many technical, social, cultural, legal, and logistical barriers to successful adoption. 9-13 Clinicians are often reluctant to use PROMs routinely because they fear it will add to their workload rather than make them more efficient and effective. Furthermore, many clinicians who do spend time talking to patients contend that they already understand their patients’ problems and do not need additional information from them. Patients generally welcome systems that routinely use PROMs. However, they say that patient reporting systems must be used well and not misdirect the focus of the clinical encounter, burden patients, or focus only on factors that have value to clinicians (box 2). Any system designed to assess and respond to patient reported outcomes must include relevant and validated measures. These must be analysed and reported appropriately and the response to them made explicit in the notes. Identifying the best way to incorporate PROMs in pre-existing medical record systems while safeguarding privacy is challenging. The best design will vary for different patient populations, practice types, and clinical settings. Below we present two cases from Sweden and the United States that show routine use of PROMs in primary and secondary care. Both systems were developed by experienced, practising physicians and share similar objectives but the design differs. Swedish rheumatology quality registry The Swedish rheumatology quality registry was established in 1995 and contains data on over 66 000 patients, about 85% of people in Sweden with rheumatoid arthritis. 14 Data generated by patients is fed into a user friendly “dashboard” and used to support care. Patient reported outcome measures are tracked over time in relation to ongoing treatment. Patients input information on both disease specific and general measures of function and health, helping clinicians to provide more appropriate and patient centred care. The dashboard displays trends and is used to guide treatment, shared decision making, and self management. Experience suggests that the registry Correspondence to: E C Nelson eugene.c.nelson@gmail.com For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe BMJ 2015;350:g7818 doi: 10.1136/bmj.g7818 (Published 10 February 2015) Page 1 of 3 Analysis ANALYSIS on 27 May 2020 by guest. Protected by copyright. http://www.bmj.com/ BMJ: first published as 10.1136/bmj.g7818 on 10 February 2015. Downloaded from