The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Abstract

Background The recent emphasis on value‐based health care (VBHC) is thought to provide new opportunities for shared decision‐making (SDM) in the Netherlands, especially when using patient‐reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. Aim To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. Approach Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. Results The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. Conclusion Successful implementation of SDM within VBHC initiatives may not be self‐evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time‐consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.

Funnel plots of patient‐reported outcomes to evaluate health‐care quality: Basic principles, pitfalls and considerations

“…That being said, we should keep in mind that individual and aggregated use often go together and may strengthen each other, for example, aggregated information is valuable when considering treatment choices and may contribute to shared decision-making (eg, prognoses on outcomes after treatments). 29 Furthermore, the use at individual level is expected to improve response rates, which in turn results in better quality of aggregated information. Finally, the ultimate aim of collecting PROs is to improve patient outcomes and quality of care, and in order to evaluate whether the use of PROs at individual level indeed results in quality improvements, data on an aggregated level is required, 30 for instance, by using funnel plots.…”

“…Individual use may therefore be the primary purpose of collecting PROs in routine care. That being said, we should keep in mind that individual and aggregated use often go together and may strengthen each other, for example, aggregated information is valuable when considering treatment choices and may contribute to shared decision‐making (eg, prognoses on outcomes after treatments) 29 . Furthermore, the use at individual level is expected to improve response rates, which in turn results in better quality of aggregated information.…”

A Value-based Steering Model for Healthcare

“…A patient may use provider-level outcomes data to choose the best provider for them [6]. A healthcare professional may use the data of their individual patient to monitor their development and to guide their care [7]. The manager of the healthcare professional may use the data to benchmark and assess the performance of each healthcare professional, to motivate healthcare professionals to actively work for better patient outcomes, and for other such management-related uses [8].…”

Editorial introduction: Decision making, reasoning, context, and perspective

“…[18][19][20] The edition concludes with a number of papers proposing innovative methods for implementing and evaluating the impact of PCC and SDM. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Again, the core concepts of PCC and SDM are explored across a very diverse set of contexts. It would of course be misleading to present this edition as the "conclusion" of the debate commenced in our previous thematic issue on this subject.…”

“…The edition concludes with a number of papers proposing innovative methods for implementing and evaluating the impact of PCC and SDM . Again, the core concepts of PCC and SDM are explored across a very diverse set of contexts.…”