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Removing the Performance Stigma

I’m frequently asked about patient-reported outcomes (PRO) in clinical decision making and quality measurement. The regular use of validated instruments that collect patient observations directly —patient-reported outcome measures (PROM)—have opened the door to a more holistic approach to assessing health care quality. But a stigma persists in quality measurement: Many clinicians are wary of how collected information might be used to assess their performance. 

Building the patient perspective into a quality reporting program can have a positive influence on a patient’s health care experiences and may influence progression to a better state of well-being. PROs, when consistently and reliably collected, are invaluable for tracking patient progress toward health goals. Validated, standardized PROMs not only accurately identify patient outcomes, but their regular use also allows progressive assessment of meaningful, clinically important differences in patient functional status and well-being. 

Attention on PROM results has recently intensified, due in part to the newly published digital quality measures that leverage FHIR-CQL standards to provide precise representations of health-care quality relevant to each patient. It’s important, however, to separate the PRO collection process from the PRO-PM assessment process. The key difference is that a PROM produces information and a PRO-PM produces knowledge by assessing individual outcomes relative to each other, along with a number of pertinent variables. The PRO-PM algorithm provides a framework that directs information generated by each PROM into useable knowledge that can support ongoing care decisions with regard to an individual’s progress on a care plan. 

In order to gain full acceptance of the new quality PRO-PM methodology, we need to start by changing how care teams are assessed and how their role is perceived by those who assess them. Toward this end, the first step is for PRO-Performance Measurement to become PRO-Progress Measurement. 

This new title reflects the intent of a comprehensive, patient-focused strategy. The core component is using information obtained from PROMs to chart a patient’s meaningful progress toward clinical and lifestyle goals that are important to them. The care team responsible for helping the patient establish and make progress toward those goals should receive credit for successful treatment that moves the patient in that direction—even if movement is incremental. Recognition of effective management will be key to removing the stigma of measurement found in traditional performance assessment models, which don’t have a way to represent incremental achievement.

In splitting from static interpretations of traditional quality measure results—where care quality is only recognized by full attainment of a series of disjointed benchmarks, regardless of their relevance to the patient—we can reduce the stigma associated with assessing quality.  

A constructive, nonpunitive approach is the hallmark of effective, person-centered quality assessment strategies. Clearly signaling the intent of these strategies will greatly advance deployment and use of the digital quality PRO-PMs, which offer many opportunities to fully appreciate the new quality paradigm .