In 2010, the Harvard Business School economist Michael E. Porter stated that “Value should always be defined around the customer, and in a well-functioning health care system, the creation of value for patients should determine the rewards for all other actors in the system. Since value depends on results, not inputs, value in health care is measured by the outcomes achieved, not the volume of services delivered, and shifting focus from volume to value is a central challenge”(1). Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) have received considerable attention in the wake of this paradigm shift towards value-based healthcare.
In this blogpost, we briefly introduce the PREMs and PROMs, how they fit into the value-based healthcare model, and most importantly, how you can get started with them.
PROs are outcomes which are directly reported by patients and typically relate to patients’ health, their quality of life and their functional ability (2). A straightforward example of a PRO would be pain; patients report their pain-score to their attending clinician using a simple numerical scale from 0 to 10, where 1 indicates the lowest pain and 10 indicates the most severe pain. A PROM which is a measure of a PRO could therefore be a Numerical Rating Scale which measures the patient’s pain. PROMs are important because they give patients a voice and allow their outcomes to be quantified and measured. Often times, these outcomes can be neglected in routine clinical visits. Examples include fatigue, mood, pain, and physical function.
Examples of routinely used PROMs are the EuroQol (EQ-5D) (3) and the Hospital Anxiety and Depression Scale (HADS) (4)
PREMs are measures of a patient’s opinion or perception of their personal experience of the healthcare which they have received (5). Like PROMs, PREMs are questionnaire-based tools which enable patients to express their opinions regarding processes which are part of an overarching workflow or patient journey. For instance, a patient who makes a visit to the outpatient oncology clinic could be surveyed on the waiting time, the politeness of the staff and the clarity of the instructions provided to her. There are several examples of PREMs which are in routine use today. Examples include the Accident and Emergency Department Questionnaire (AEDQ)(6), the National Inpatient Survey, the navigated transcranial magnetic stimulation (nTMS) -PREMS(7), and the Consumer Assessment of Healthcare
Providers and Systems (CAHPS) PREMS(8) amongst others. In truth, any questionnaire which captures what happened during an episode of care, together with how it happened from the perspective of the patient, can be construed as a PREMs instrument.
Ideally, PROMs and PREMs should be co-designed and co-developed between clinical researchers, patients, and subject matter experts (e.g. physicians and nurses). The literature, however, is rich with validated and evidence-based PROMs and PREMs. Healthcare professionals who are eager to implement PROMs and PREMs in their practice are encouraged to do a brief literature review to source out established PROMs and PREMs which are easily replicable.
Importantly, the patient is at the heart of the healthcare experience and the design and implementation of PROMs and PREMs should reflect that. The patient population should ideally be specific (e.g. breast cancer patients on chemoradiotherapy) and the user experience (UX) persona should be crafted out to maximise usability. Since the reporting of PROMs and PREMs is almost always unsupervised, the way in which they are presented can significantly enhance or impede compliance. Avoid using inconsistently aligned text and small and unclear font.
Although PREMs and PROMs have traditionally been disseminated in the form of paper questionnaires, there has been a pivotal shift towards full electronisation – PREMs and PROMs can be easily accessed on mobile phones and tablet devices. Remecare empowers clinicians with the flexibility of integrating PREMs and PROMs into its sophisticated and user-friendly remote monitoring solution. Remecare is firm about putting the patient at the centre of the healthcare experience – this philosophy is congruent with our design thinking process. The target patient population should be specific and the UX persona should be detailed in order to maximise the usability of PREMs and PROMs.
Remecare provides a golden opportunity to healthcare institutions to embrace ground-breaking technology and realising the vision of personalised medicine in a volatile, uncertain, complex, and ambiguous world. We endeavour to identify the pain-points in the patient journey in order to achieve a safer, more effective, highly personalised and satisfying clinical experience for both patients and healthcare providers alike.