Abstract
Purpose
To assess the impact of providing healthcare professionals with feedback on patient-reported outcome measures (PROMs).
Methods
This is a systematic review including controlled studies investigating the effectiveness of PROMs feedback, specifically examining the impact at a group-level and a patient-level.
Results
Only one study provided feedback at a group-level as a measure of professional performance, which found no intervention effect. At a patient-level, sixteen studies were identified and only one study found an overall significant difference in the PROM score. However, an additional six studies found a significant result favouring the intervention group for a particular subgroup or domain. The studies which demonstrated the greatest impact primarily used PROMs as a management tool in an outpatient setting on a specialised patient population. In contrast, there was weak evidence supporting with the use of PROMs as a screening tool. The studies which found a positive effect had a lower quality score on average.
Conclusions
The effectiveness of PROMs feedback seems to be related to the function of the PROM. However, the evidence regarding the impact of PROMs feedback on patient outcomes is weak, and methodological issues with studies are frequent. The use of PROMs as a performance measure is not well investigated. Future research should focus on the appropriate application of PROMs by testing specific hypothesis related to cause and effect. Qualitative research is required to provide a deeper understanding of the practical issues surrounding the implementation of PROMs and the methodological issues associated with the effective use of the information.
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Abbreviations
- PROMs:
-
Patient-reported outcome measures
- NHS:
-
National Health Service
- RCT:
-
Randomised controlled trial
- PICO:
-
Patient, intervention, comparison, outcome
- SMD:
-
Standardised mean difference
References
Rosenbloom, S. K., Victorson, D. E., Hahn, E. A., Peterman, A. H., & Cella, D. (2007). Assessment is not enough: a randomized controlled trial of the effects of HRQL assessment on quality of life and satisfaction in oncology clinical practice. Psychooncology, 16(12), 1069–1079. doi:10.1002/pon.1184.
Greenhalgh, J., & Meadows, K. (1999). The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: A literature review. Journal of Evaluation in Clinical Practice, 5(4), 401–416.
Deyo, R. A., & Carter, W. B. (1992). Strategies for improving and expanding the application of health status measures in clinical settings. A researcher-developer viewpoint. Medical Care, 30(5 Suppl), MS176–MS186 (discussion MS196-209).
Greenhalgh, J., Long, A. F., & Flynn, R. (2005). The use of patient reported outcome measures in routine clinical practice: Lack of impact or lack of theory? Social Science and Medicine, 60(4), 833–843. doi:10.1016/j.socscimed.2004.06.022.
Luckett, T., Butow, P. N., & King, M. T. (2009). Improving patient outcomes through the routine use of patient-reported data in cancer clinics: Future directions. Psychooncology, 18(11), 1129–1138. doi:10.1002/pon.1545.
Sutherland, H. J., & Till, J. E. (1993). Quality of life assessments and levels of decision making: Differentiating objectives. Quality of Life Research, 2(4), 297–303.
Till, J. E., Osoba, D., Pater, J. L., & Young, J. R. (1994). Research on health-related quality of life: Dissemination into practical applications. Quality of Life Research, 3(4), 279–283.
Devlin, N., & Appleby, J. (2010). Getting the most out of PROMs: Putting health outcomes at the heart of NHS decision-making. London: King’s Fund.
Canadian Institute of Public Health. (2012). Health outcomes of care: An idea whose time has come. Ontario: Ottawa.
Health Services Advisory Group. (2011). Medicare Health Outcomes Survey. http://www.hosonline.org/. Accessed 17/11/11.
Appleby, J., & Devlin, N. (2004). Measuring success in the NHS. Using patient-assessed health outcomes to manage the performance of healthcare providers. London: King’s Fund.
Leonard, K. L., & Masatu, M. C. Using the Hawthorne effect to examine the gap between a doctor’s best possible practice and actual performance. Journal of Development Economics. (in press, corrected proof). doi:10.1016/j.jdeveco.2009.11.001.
Moriarty, J. P., & Smallman, C. (2009). En route to a theory of benchmarking. Benchmarking: An International Journal, 16(4), 484–503.
Bridgewater, B., Grayson, A. D., Brooks, N., Grotte, G., Fabri, B. M., Au, J., et al. (2007). Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: An analysis of 25,730 patients undergoing CABG surgery under 30 surgeons over eight years. Heart, 93(6), 744–748. doi:10.1136/hrt.2006.106393.
Keogh, B., Spiegelhalter, D., Bailey, A., Roxburgh, J., Magee, P., & Hilton, C. (2004). The legacy of Bristol: Public disclosure of individual surgeons’ results. BMJ, 329(7463), 450–454. doi:10.1136/bmj.329.7463.450.
Petersen, L. A., Woodard, L. D., Urech, T., Daw, C., & Sookanan, S. (2006). Does pay-for-performance improve the quality of health care? Annals of Internal Medicine, 145(4), 265–272.
Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O’Brien, M. A., & Oxman, A. D. (2006). Audit and feedback: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (2), CD000259. doi:10.1002/14651858.CD000259.pub2.
Fung, C. H., Lim, Y. W., Mattke, S., Damberg, C., & Shekelle, P. G. (2008). Systematic review: The evidence that publishing patient care performance data improves quality of care. Annals of Internal Medicine, 148(2), 111–123.
Coulter, A., & Ellins, J. (2006). Patient-focused interventions. A review of the evidence. London: The Health Foundation.
Espallargues, M., Valderas, J. M., & Alonso, J. (2000). Provision of feedback on perceived health status to health care professionals: A systematic review of its impact. Medical Care, 38(2), 175–186.
Marshall, S., Haywood, K., & Fitzpatrick, R. (2006). Impact of patient-reported outcome measures on routine practice: A structured review. J Eval Clin Pract, 12(5), 559–568. doi:10.1111/j.1365-2753.2006.00650.x.
Gilbody, S. M., House, A. O., & Sheldon, T. (2002). Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome–a systematic review. Psychological Medicine, 32(8), 1345–1356.
Gilbody, S. M., House, A. O., & Sheldon, T. A. (2001). Routinely administered questionnaires for depression and anxiety: Systematic review. BMJ, 322(7283), 406–409.
Valderas, J. M., Kotzeva, A., Espallargues, M., Guyatt, G., Ferrans, C. E., Halyard, M. Y., et al. (2008). The impact of measuring patient-reported outcomes in clinical practice: A systematic review of the literature. Quality of Life Research, 17(2), 179–193. doi:10.1007/s11136-007-9295-0.
Department of Health & Children. (2001). Primary care: A new direction. Dublin: Government of Ireland.
Calman, K., & Hine, D. (1995). Policy framework for commissioning cancer services: A report by the expert advisory group on cancer to the chief medical officers of England and Wales. London: Department of Health.
Mental Health Commission. (2006). Multidisciplinary team working: From theory to practice- discussion paper, Dublin.
Smith, S., Cano, S., Lamping, D., Staniszewska, S., Browne, J., Lewsey, J., et al. (2005). Patient-reported outcome measures (PROMs) for routine use in treatment centres: Recommendations based on a review of the scientific evidence. London: Department of Health.
Robinson, K. A., & Dickersin, K. (2002). Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. International Journal of Epidemiology, 31(1), 150–153.
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J., Gavaghan, D. J., et al. (1996). Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clinical Trials, 17(1), 1–12.
Fayers, P. M. (2008). Evaluating the effectiveness of using PROs in clinical practice: A role for cluster-randomised trials. Quality of Life Research, 17(10), 1315–1321. doi:10.1007/s11136-008-9391-9.
Cohen, J. (1969). Statistical power analysis for the behavioral sciences. New Jersey: Lawrence Arlnaum Associates Inc.
Calkins, D. R., Rubenstein, L. V., Cleary, P. D., Davies, A. R., Jette, A. M., Fink, A., et al. (1994). Functional disability screening of ambulatory patients: A randomized controlled trial in a hospital-based group practice. Journal of General Internal Medicine, 9(10), 590–592.
Dowrick, C., & Buchan, I. (1995). Twelve month outcome of depression in general practice: Does detection or disclosure make a difference? BMJ, 311(7015), 1274–1276.
German, P. S., Shapiro, S., Skinner, E. A., Von Korff, M., Klein, L. E., Turner, R. W., et al. (1987). Detection and management of mental health problems of older patients by primary care providers. JAMA, 257(4), 489–493.
Kazis, L. E., Callahan, L. F., Meenan, R. F., & Pincus, T. (1990). Health status reports in the care of patients with rheumatoid arthritis. Journal of Clinical Epidemiology, 43(11), 1243–1253.
Mathias, S. D., Fifer, S. K., Mazonson, P. D., Lubeck, D. P., Buesching, D. P., & Patrick, D. L. (1994). Necessary but not sufficient: The effect of screening and feedback on outcomes of primary care patients with untreated anxiety. Journal of General Internal Medicine, 9(11), 606–615.
Rubenstein, L. V., Calkins, D. R., Young, R. T., Cleary, P. D., Fink, A., Kosecoff, J., et al. (1989). Improving patient function: A randomized trial of functional disability screening. Annals of Internal Medicine, 111(10), 836–842.
Rubenstein, L. V., McCoy, J. M., Cope, D. W., Barrett, P. A., Hirsch, S. H., Messer, K. S., et al. (1995). Improving patient quality of life with feedback to physicians about functional status. Journal of General Internal Medicine, 10(11), 607–614.
White, P., Atherton, A., Hewett, G., & Howells, K. (1995). Using information from asthma patients: A trial of information feedback in primary care. BMJ, 311(7012), 1065–1069.
Whooley, M. A., Stone, B., & Soghikian, K. (2000). Randomized trial of case-finding for depression in elderly primary care patients. Journal of General Internal Medicine, 15(5), 293–300.
Wasson, J. H., Stukel, T. A., Weiss, J. E., Hays, R. D., Jette, A. M., & Nelson, E. C. (1999). A randomized trial of the use of patient self-assessment data to improve community practices. Eff Clin Pract, 2(1), 1–10.
Trowbridge, R., Dugan, W., Jay, S. J., Littrell, D., Casebeer, L. L., Edgerton, S., et al. (1997). Determining the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer. Academic Medicine, 72(9), 798–800.
Lambert, M. J., Whipple, J. L., Smart, D. W., Vermeersch, D. A., & Nielsen, S. L. (2001). The effects of providing therapists with feedback on patient progress during psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11(1), 49–68.
Hawkins, E. J., Lambert, M. J., Vermeersch, D. A., Slade, K. L., & Tuttle, K. C. (2004). The therapeutic effects of providing patient progress information to therapists and patients. Psychotherapy Research, 14(3), 308–327.
McCoy, J. M., Rubenstein, L., Hirsch, S. H., & Barrett, P. A. (1988). A feedforward system for functional status information. Proceedings of the Annual Symposium on Computer Applications in Medical Care, 9, 683–686.
Puschner, B., Schöfer, D., Knaup, C., & Becker, T. (2009). Outcome management in in-patient psychiatric care. Acta Psychiatrica Scandinavica, 120(4), 308–319.
Gutteling, J. J., Darlington, A. S., Janssen, H. L., Duivenvoorden, H. J., Busschbach, J. J., & de Man, R. A. (2008). Effectiveness of health-related quality-of-life measurement in clinical practice: A prospective, randomized controlled trial in patients with chronic liver disease and their physicians. Quality of Life Research, 17(2), 195–205. doi:10.1007/s11136-008-9308-7.
Weingarten, S. R., Kim, C. S., Stone, E. G., Kristopaitis, R. J., Pelter, M., & Sandhu, M. (2000). Can peer-comparison feedback improve patient functional status? American Journal of Managed Care, 6(1), 35–39.
Berking, M., Orth, U., & Lutz, W. (2006). How effective is systematic feedback of treatment progress to the therapist? An empirical study in a cognitive-behavioural- oriented inpatient setting. Zeitschrift fur Klinische Psychologie und Psychotherapie, 35, 21–29.
Acknowledgments
This work was funded by the Health Research Board in Ireland under Grant No. PHD/2007/16.
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Boyce, M.B., Browne, J.P. Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review. Qual Life Res 22, 2265–2278 (2013). https://doi.org/10.1007/s11136-013-0390-0
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DOI: https://doi.org/10.1007/s11136-013-0390-0