25.11.2019

Patient-centred care – how to get there

Relevance and Benefit of Patient Reported Outcomes Measures (PROMs) and Value-based Healthcare (VBHC)

  • In medicine a pradigm shift towards patient-centred care can be observed.
  • Patient-Reported Outcome Measures (PROMs) and Value Based Healthcare (VbHC) are core ideas
  • In a context of increasing economic pressure, those ideas might help make healthcare more efficient without neglecting the patients’ well-being

patient-centred care
A paradigm shift in healthcare

The prism through which healthcare is viewed is experiencing a transition, a paradigm shift if you will. Healthcare providers aim to put patients wellbeing at the heart of medicine through implementing value-based healthcare and patient reported outcome measures (PROMs). The hope is to better determine the effectiveness of various therapeutic strategies and in evaluating clinical care. The aim? To ultimately improve patient quality of life.

This adjustment requires measuring health outcomes that actually matter to patients and the resources to deliver those outcomes across the full cycle of care in a system. In turn, that makes increased patient feedback (of symptoms or the effects the prescribed treatment or procedure has on their daily lives) necessary.1 

The need to measure “more”

In drug development, for example, pharma acknowledged how pivotal it was to consider patient-reported outcomes (PROs) along with biomarkers which were indicative of health improvement. As treatment outcomes may not necessarily coincide with overall health outcomes that have an impact on patient’s day to day lives, the need for recognisable, reliable and accurate PROMs is clear.2

PROMs are the tools used to measure PROs. They evaluate a patient’s general state of well being through a diverse array of self-completed questionnaires before and after their clinical intervention. Traditionally, clinical outcomes are measured by the patient’s morbidity or mortality. By anyone’s standards, these parameters are not exactly providing a well rounded insight into the general health of the patient nor an evaluation of healthcare services. 

Different perceptions of quality

Let’s take Germany, for example. The quality of the German healthcare system is largely defined by the absence of errors. Low complication rates and, depending on the intervention, low mortality rates are largely regarded as the most important signs of good treatment quality. 

Whilst in the United Kingdom, the NHS was ranked by the Commonwealth Fund as the best performing healthcare system out of 11 countries, including Germany, Australia and the United States. The interesting thing here is that despite this “achievement” in the rankings, 82% of the general public expressed concerns regarding the future of the NHS in a survey after the General Election in 2017. The public identified “quality of care” as being one of the reasons for dismay. This begs the question, is there a detachment between a healthcare system’s perception of its own outcomes versus the quality of care perceived by patients when assessing the NHS?2,3

This reinforces how valuable and often times accurate a patient’s vantage point with regards to their own health status and the quality of the services they receive is when assessing treatment and healthcare services. 

PROMs – asking patients the right way

So how do PROMs really work? Through the use of scientifically validated PROs, determined by a diverse array of questionnaires, the patient’s statements can ultimately be converted into scores and thus the patient’s current state of health can be presented.

A survey at several points in time then enables, for example, a comparison between pre- and post-therapeutic condition. If the survey of PROs is carried out in advance at home via e-mail or in the waiting room via tablets, the patient and their physician can discuss the results and evaluate the current course of treatment. If the score or the patient’s state of health does not develop as expected, it would be possible to intervene, thus problems can be identified at an earlier stage.4

The impact of measuring PROMs

Cancer patients of the Memorial Sloan Kettering Cancer Center had an average of 5.5 months longer survival with active PRO monitoring. In the field of oncology, the Memorial Sloan Kettering Cancer Center in New York showed that their cancer patients with active monitoring with PROs had an average survival time of 5.5 months longer.5

Patient Reported Outcomes are a fundamental building block of the Value-Based Healthcare Model. They must be incorporated into healthcare as an important indicator of treatment quality and analyzed to determine the means, costs and changes in patients’ quality of life. Thus, it emerges which therapies are really medically useful and how to optimise the use of limited financial resources. This ultimately offers the unique opportunity of financial savings while improving the quality of treatment – economic and medical performance increases.

Patient-centred care pays off

At a time when heavy competition and limited financial resources are putting hospitals throughout Europe under economic pressure, the players must reposition themselves in order to be able to survive on the market in the long term. For the management of the clinics, this inevitably leads to the redistribution or reduction of resources – ideally without neglecting the patients’ well-being. In this process, hospitals must offer the best possible treatment quality and successfully communicate it to patients and their referring physicians. This creates trust and is a decisive competitive factor in the health care system of today and tomorrow.

Considering the above, healthcare providers can be hesitant, because PROs will consume one of their most precious commodities – time. PROs collection may represent an additional task to an already overloaded schedule. However, the systematic collection of outcomes has benefits and studies are continuously published illustrating the patient and financial benefits of this practice. A recently published paper in association with Dr. Ethan Basch showed the cost-effectiveness of web-based PRO surveillance in patients with lung cancer.6

To surmise, patients, doctors and clinics must work together with PROs to achieve a better healthcare system. This entire path must be shared by patients, physicians and clinics with PROs for a more sustainable, high-quality and above all patient-centred care.

Patient-centred care - how to get there 1
written by
Léa Marais

Director of International Operations, UK-based with track record in PROMs delivery to healthcare providers, responsible for international operations at heartbeat

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Sources:

  1. Larsson, S. (2018). Mobilizing cooperation for health system transformation. [online] Linkedin.com. Available at: https://www.linkedin.com/pulse/mobilizing-cooperation-health-system-transformation-stefan-larsson/ [Accessed 1 Jul. 2019].
  2. Wilke RJ, Burke LB, Erickson P. Measuring treatment impact: a review of patient-reported outcomes and other efficacy endpoints in approved product labels. Control Clin Trials. 2004;25(6):535–552.
  3. Friebel, R. (2017). Measuring quality of health care in the NHS | The Health Foundation. [online] The Health Foundation. Available at: https://www.health.org.uk/blogs/measuring-quality-of-health-care-in-the-nhs-giving-a-voice-to-the-patients [Accessed 1 Jul. 2019].
  4. Murphy, J. (2019). Patient Reported Outcomes: – Irish Medical Journal. [online] Imj.ie. Available at: http://imj.ie/patient-reported-outcomes/ [Accessed 1 Jul. 2019].
  5. Basch, E., Deal, A.M., Dueck, A.C., Scher, H.I., Kris, M.G., Hudis, C. and Schrag, D., 2017. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. Jama, 318(2), pp.197-198.
  6. Lizée, T., Basch, E., Trémolières, P., Voog, E., Domont, J., Peyraga, G., Urban, T., Bennouna, J., Septans, A.L., Balavoine, M. and Detournay, B., 2019. Cost-effectiveness of web-based patient-reported outcome surveillance in patients with lung cancer. J Thorac Oncol, 14, pp.1012-1020