NEJM ‘Perspective’ explores use of patient-reported outcomes in improving clinical care
February 2, 2017
A ‘Perspective’ column published in the Jan. 12 New England Journal of Medicine calls for digitized patient-reported outcomes to be more fully available to physicians as a means of improving patients’ care.
The article’s author is Ethan Basch, MD, professor of health policy and management at the UNC Gillings School of Global Public Health and director of the Cancer Outcomes Research Program at UNC Lineberger Comprehensive Cancer Center. Basch also is professor of hematology and oncology in the UNC School of Medicine.
Patients often do not describe their symptoms or health issues with health-care providers, especially when such incidents occur between clinic visits. Since these data are not included in electronic health records, providers may not be able to alleviate a patient’s concerns or discomforts. Neither may a provider have the information he or she needs to conduct quality-of-care evaluations or comparative effectiveness research. (The latter is a direct comparison of possible health-care interventions to determine which treatment works best for whom—and under which circumstances.)
Basch describes three barriers to the implementation of patient-recorded outcomes data as part of routine care delivery – technology, reimbursement and lack of standardized methods for integrating the data into clinical workflow.
He suggests that current electronic health records could be improved by allowing patients to use their own technological devices to upload information rather than having to report information through a website’s patient portal.
Though Medicare and other insurers recognize the value of collecting patient-reported outcomes, there is no financial incentive for implementing data systems to capture those outcomes.
Collecting patient-reported outcomes data requires providers to devise an effective approach for responding to the data without disrupting normal workflow. This may include processing these data through the same “in-basket” used for patient-portal messages.
“Other challenges,” Basch writes, “are surmountable” – including ensuring data privacy and security, minimizing missing data, and analyzing the information.
“There is sufficient scientific rational and understanding of implementation methods to expand collection of patient-reported outcomes data in clinical care,” he writes. “Doing so could turn the rhetoric regarding ‘patient-centered care’ into a reality.”