01.08.2019

Improve Patient Engagement for PROMs

With these 3 aspects you can easily improve patient engagement when participating in Patient Reported Outcome Measures (PROMs).

Improve Patient Engagement for PROMs 1
3 key aspects to improve patient engagement with PROMs:

1. Making it easy: reach patients where it is convenient for them and provide a simple user-friendly interface. 

2. Making it relevant to the patient: look at and use patient responses in real-time to care for the patient. 

3. Making it speedy: Do not ask too many questions and do not ask too frequently. 

Value in Patient Engagement

Patient-Reported Outcome Measures (PROMs) aim to assess how the patient perceives their quality of health before and after a medical intervention.1 A common PROM may determine a patient’s degree of mobility following a hip replacement procedure or if the patient feels like they can carry out everyday activities like dressing themselves following a stroke. Ultimately, PROMs allow for the value of a clinical intervention to be evaluated by what matters most to the patient.2 Typically, PROMs are completed in the clinic or at home before and after medical treatment, they can be paper based or digital. In order for PROMs to be useful for the individual and for the wider patient population – patient engagement with the initiative is key. 

Patient engagement is an invaluable part of healthcare today, regardless of age, gender, origin or illness. Gradually healthcare organisations are beginning to see the value in the incorporation of Patient Reported Outcome Measurements (PROMs), data and digital technology in routine clinical practice.3 Without active patient participation in these efforts, they are non-informative and essentially obsolete.

Examining how patients actually experience their care and quality of life outcomes along with functional status has to come from the patient themselves! We must not forget that engagement starts between doctors and patients directly. Engagement pivots on physicians informing patients how valuable PROMs participation is in influencing their own treatment but also gathering information to help similar patients in the future. So how do healthcare providers who value data generated from digitally collected-PROMs ensure that patients actually participate? 

Ease of use platforms improves patient engagement

To put it into simple terms – if something is difficult to use, we simply will not use it. This rule of thumb is even more applicable in a busy healthcare setting – a hub of busy staff and patients in pain. If a PROMs collection system is uncomplicated to interact with then it promotes patient and healthcare staff engagement. To enhance the ease of use of a digital PROMs collecting technology an uncomplicated design is paramount as well as clear text and labels for the patient’s use. Different patients suffer with different physical and mental ailments, so tailoring a PROMs dashboard to the patient cohort of interest can be a difficult hurdle to jump. For example, it is complicated to collect outcomes for those having suffered a stroke.4

Moreover, how the field enables PROMs instruments to be appropriately used by patients with dementia and their carers to give reliable reports of the patient’s health are ongoing considerations.5 There are many avenues whereby innovation is essential to overcome the challenges that PROMs collection to enhance engagement amongst all patients with a diverse range of impairments.

Healthcare professionals need to be mindful when selecting their PROMs questionnaires.  Patient engagement drastically decreases if too many, repetitive questions are asked. The majority of patients will lose interest if they are faced with too many questions, so platform developers should avoid PROM questions that may overwhelm patients. In a 2017 study, researchers reviewing various PROM case studies determined that the key to patient completion of PROMs depended on a usable tool with a succinct question sets.6

Busy environments as a challenge for patient engagement

We live in a very busy world, everyone has somewhere to go, something to do or someone to meet. Considering this, care teams need to avoid extensive PROMs question sets that need to be relatively quick to complete. Our bustling worlds simply to not have inordinate amounts of time to dedicate to completing questionnaires – therefore to maximise patient participation PROMs completion needs to be speedy! 

Dr. Neil W. Wagle, highlighted that an electronic PROMs platform must be user friendly to all and should work with the clinic’s patient portal via WiFi-connected tablets.7 Wagle elaborated that such platforms must work almost perfectly as “neither patients nor providers have the patience for glitches”.

Utilising PROMs for the individual spurs patient engagement 

The last thing many of us want to do when we are suffering from a medical condition or following a procedure is engage with technology when we do not see that benefit to us as individuals. If we do not see how we can directly benefit from participating in something, we find it difficult to donate our precious time and brain-power to it. 

The National PROMs Programme rolled out in the NHS in 2009, which focused on four surgical procedures (mainly in the area of orthopaedics) suffered some criticism as Walker et al., pointed out that the published data had “very limited clinical benefit to an individual surgeon or patient”.8 Walker accredited the lack of utility of the data to the requirement of paper questionnaires to be produced, completed, returned before being manually being entered into a database resulting in long delays and not providing surgeon-specific feedback. Considering this, the individual needs to see the benefit from PROMs data during the course of their treatment. Enhancing PROMs patient engagement requires the analysis and use of responses in real time to care for the individual.

A patient’s age is mind over matter

Many PROMs programmes focus mainly on orthopaedics, which are health problems that traditionally affect older demographics. In light of the fact that there will be approximately 2.1 billion people over the age of 60 by 20509, can older patients partake in the digital evolution of PROMs data collection? 

It seems that older people may be more tech savvy than initially thought, despite concerns raised regarding electronic PROMs collection in this cohort.10 Interestingly, internet consumption is rather high across all ages in the United Kingdom with roughly 41% of adults aged 75 and over using the internet. Figures suggest that this is an approximate 20% increase since 2011 with the rising trend of technological capabilities in later life likely to continue.11 Accenture conducted a survey in 2015 which revealed that 67% of elderly internet users would like to access healthcare services from home. The results illuminated that the elderly who embrace technology demonstrate a greater predisposition to proactively manage their health.12 Moreover, as our population ages the more technologically advanced and capable they will be. This could mean that age and engagement with the digital world may not even be a consideration in the future.

The results illuminated that the elderly who embrace technology demonstrate a greater predisposition to proactively manage their health.12 Moreover, as our population ages the more technologically advanced and capable they will be. This could mean that age and engagement with the digital world may not even be a consideration in the future.

How does heartbeat improve patient engagement?

heartbeat has adopted techniques to improve patient engagement and to ensure that both the patient and doctor have a user-friendly experience. The software has evolved to ensure that it is easy to use, it is quick and is relevant to the individual’s healthcare and not just a population-wide data collecting tool. 

heartbeat makes PROMs engagement an effortless experience. Patient experience is at the heart of Heartbeat’s design, our designers always consider the patient and their status of health when creating or updating new interfaces. The company fosters innovation and new additions to enhance the accessibility of our questionnaires are in the pipeline. With Heartbeat, the patient does not need to install any app. Through sending out automatic email alerts at scheduled time-points for PROMs completion, the patient can participate from the comfort of their own home. It is as simple and as easy as that!

heartbeat works in conjunction with providers to build standard PROMs sets in various different disease pathways. Our ICHOM accredited product is a quick solution that measures what really matters to patients and guides clinicians as to what is actionable to them. We have developed our patient data collecting interface to be fast to use for the patient and to slot into the busy workflow of the care teams treating them.

The personalised nature of heartbeat means that treating physicians know the health status of their patients even before the first meeting, and can track this in the long term through real-time reporting. Heartbeat understands how crucial patient engagement is to PROMs success and so we aspire to enhance our tool to make PROMs collection as easy, speedy and personal as possible. In a recently published paper, it was established that our response rates are up to 83%.12 Patient engagement is key to PROMs success and Heartbeat is proud to optimise this!

Improve Patient Engagement for PROMs 2
written by
Katie O’Keeffe

Medicine and healthcare writer, responsible for international healthcare research at heartbeat.

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Sources:

  1. https://patientengagementhit.com/news/overcoming-the-top-patient-reported-outcomes-measures-challenges (Accessed August 1st 2019)
  2. https://academic.oup.com/bjaed/article/17/4/137/2999278 (Accessed August 1st 2019)
  3. https://link.springer.com/content/pdf/10.1007%2Fs10620-017-4658-z.pdf (Accessed August 1st 2019)
  4. https://www.stroke.org.uk/research/what-factors-affect-stroke-survivors-ability-complete-patient-reported-outcome-measures (Accessed August 1st 2019)
  5. https://www.kingsfund.org.uk/sites/default/files/media/Dr%20Sarah%20Smith%20-%20PROMs%20in%20dementia%20care.pdf (Accessed August 1st 2019)
  6. https://www.ncbi.nlm.nih.gov/pubmed/29881737 (Accessed August 1st 2019)
  7. https://catalyst.nejm.org/measuring-matters-capturing-patient-voice/ (Accessed August 1st 2019)
  8. https://www.ncbi.nlm.nih.gov/pubmed/28739626 (Accessed August 1st 2019)
  9. https://population.un.org/wpp/DataQuery/ (Accessed August 1st 2019)
  10. https://www.ncbi.nlm.nih.gov/pubmed/16987118 (Accessed August 1st 2019)
  11. https://www.pewresearch.org/global/2018/01/11/detailed-tables-global-media-habits/ (Accessed August 1st 2019)
  12. https://newsroom.accenture.com/industries/health-public-service/tech-savvy-seniors-want-online-options-to-access-care-from-home-accenture-survey-shows.htm (Accessed August 1st 2019)