PROMs stands for “Patient Reported Outcome Measures,” which are a way to measure some of the most important reasons people seek care: symptoms, function, and quality of life. For example, most people seek care for their knee when it hurts or when they have trouble walking or getting through their daily activities. PROMs uses patient answers to validated questionnaires to turn symptoms like knee pain and daily functioning into scores that can be followed over time. Following these symptoms allow providers to take better care of patients.
At Mass General Brigham, PROMS are used not only to look at an individual’s outcomes, but grouped together to help provide better guidance for our patients and to improve the quality of our care. We can put the knee pain results from thousands of patients who have had a knee replacement together to be able to help patients who are about to have surgery be able to answer questions like, How long is it going to take me to get better? Will I be able to take care of myself when I go home? Will I be able to play sports again? These help patients make the best decision possible.
We can also use PROMs grouped together to better understand which kinds of patients benefit most from one treatment versus another. We know that some patients benefit tremendously from surgery and others do just as well with less invasive treatments like physical therapy. By looking at PROMs from thousands of patients, we can better understand which treatment is most likely to benefit which kinds of patients.
Patients answer their PROMs questionnaires during the course of their care at Mass General Brigham. There are many different types of questionnaires depending on the diagnosis—the KOOS measures knee pain, the SAQ asks about angina (heart pain), and the IPSS measures urinary symptoms. The questions are simple ones like, “How much difficulty have you had rising from bed because of your knee pain?” or “Over the past 4 weeks, how often have you had chest pain, chest tightness, or angina?” The good thing about these questionnaires is that they’ve been established for years from around the world and have already gone through a vigorous process to be validated in a clinical setting.
The PROMs program has taken what used to be paper forms, digitized them, and turned them into a quantifiable way to see how our patients are doing over time. If you are enrolled in Patient Gateway, our patient portal, you will receive a notification to submit PROMs before an upcoming visit or possibly before surgery. If you can’t answer at home, when you arrive at your appointment, many clinics now have iPads available for you to answer in the waiting room or sometimes even alongside your doctor at a computer in the exam room.
Depending on what treatment course you are on, you might answer these questions once per visit, once per year, or on a regular schedule. For patients undergoing surgery, for example, we ask you to submit your PROMs before surgery and at 3 months, six months, and annually after your surgery. Your answers are stored in your electronic health record and can be used to look at your outcomes over time to make sure you have the best possible outcome.
After collecting patient data with PROMs, a Mass General Brigham physician can show a patient how their results are trending over time. The questionnaires are not only compiled into a general overview; the doctor can go in and see how much or little the patient improved in specific areas like day-to-day activities or symptoms of depression. This allows doctors to look at a patient’s progress as well as their specific needs. This is also where physicians can find and address deficiencies. For example, maybe the patient is taking a long time to recover. Reviewing the PROMs questions can pinpoint specific causes hindering recovery. These might be too little physical therapy, anxiety or depression, or social limitations—by finding the root cause, physicians can better help the patient get well.
Clinical Decision Making
One of our objectives for the future is compiling enough data so that down the road we can see a patient, be able to predict the outcomes, and let the patient choose whether they want to do the procedure or not. For example, a patient could come in complaining of low back pain: should they have a surgery or an injection or go to physical therapy? There is usually not a single “best” treatment that is the same for everyone, but if we have substantial data on recovery rates, comorbidities, etc., we can help patients figure out where they are most likely to have the best outcome for them based on their unique characteristics and history.
A robust collection of data also shows clinical strengths and weaknesses across the entities. What if a particular surgeon has much higher outcomes than their peers? What is that provider doing that makes the outcomes better? How can we replicate that with the rest of the providers within our system? By looking at outcome data, we can improve the quality of performance across all of Mass General Brigham. PROMs is still a new field, and at Partners we are at the forefront of learning how to use this information to provide the best care for our patients.