Patient-Reported Outcomes In Performance Measurement

Abstract

The National Quality Forum (NQF), a national organization that has been deeply involved in moving the quality-improvement agenda forward for many years (http://www.qualityforum.org), endorses and promulgates quality-ofcare and performance measures that various provider groups, regulatory agencies, payers and insurers, and others can use for accountability and quality improvement activities. In 2012 and 2013, the organization began an initiative to find PROs that might be added to its extensive collection of performance measures. Its National Voluntary Consensus Standards for Patient Outcomes: A Consensus Report defined outcomes as being important because they "reflect the reason that an individual seeks healthcare services. " 1 The individual patient's voice in many performance measures, however, has largely been missing. Few ways to assess performance are available at the organizational level, even though patients are often the best able to report on the experiences and results of their individual care.To fill that gap, NQF convened an expert panel at two public meetings and, as background for its deliberations, commissioned two authoritative background papers. This monograph is a revised and updated version of the first of these two papers, which provided the background on issues about selecting PROs for use in a variety of applications pertinent to the NQF mission and activities. The second paper, Patient-Reported Outcomes in Performance Measurement, 9 dealt with issues relating to processes for endorsing performance measures that reflect the end results (ultimate outcomes) of health care. Its primary focus was on accountable health care organizations.This monograph applies the conceptual and organizational frameworks that NQF has pioneered in the past decade or so. NQF distinguishes PROs, patientreported outcome measures (or PROMs), and patient-reported outcome performance measures (or PRO-PMs). NQF endorses PRO-PMs through transparent and consensus-based procedures. This monograph addresses the PROs that are likely to be used to inform PRO measures (PROMs) that would underpin scientifically acceptable and feasible performance measures. We do not address issues with identifying, evaluating, or endorsing PRO-PMs for health care organizations or clinicians. Key Concept DefinitionPatient A person who is receiving health care services or using long-term health care support services. Patientreported outcome (PRO)Any information on the outcomes of health care obtained directly from patients without modification by clinicians or other health care professionals. For purposes of this monograph, we use this term broadly to include any patient input, whether or not it is standardized or gathered with a structured questionnaire. Patientreported outcome measure (PROM)Any standardized or structured questionnaire regarding the status of a patient's health condition, health behavior, or experience with health care that comes directly from the patient (i.e., a PRO). The use of a structured, standardized tool such as a PROM wi...

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“…For our purposes, it can be defined as the extent to which a concept, measurement, or conclusion is well-founded and corresponds accurately to the real world. 76,83 The validity of a measurement tool (e.g., a test in education, a battery of patient-reported outcomes; an instrument in chemistry) is considered to be the degree to which the tool measures what it claims to measure. In the area of scientific research design and experimentation, validity refers to whether a study is able to answer scientifically the questions it is intended to answer.…”

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