PROMs as an intervention – a randomised controlled study

Abstract

Abstract Issue Patient-Reported Outcome Measures (PROMs) are becoming part of the patient journey and are increasingly used as a mechanism to reward quality and to indicate the 'value' of the health care provided. However, only in rare cases, PROMs are not only applied to measure quality but used as a basis for medical intervention. Description of the problem Digitisation and patient-centred care are of major importance to highlight quality deficiencies and to promote transparency of patient pathways. However, there is little evidence on how to use the patient's feedback to transform the patient journey and to improve health outcomes. Additionally, there is rare information on scientifically tested or elaborated threshold values that could be applied to trigger an intervention in case of critical recovery. The patient's reaction to such interventions or alerts is unknown, although it promotes health literacy and could support cross-sectoral care and better health outcomes. Results In our two-arm RCT, we examine the effects of PROMs as an intervention and related health care costs by digitally collecting PROMs of around 10,000 patients in the field of endoprosthetics in 9 German clinics. The magnitude of the study and its digital approach suggest that the procedure can be easily transferred to other indications and countries. For the after-care period, PROM threshold alert values were defined with the support of an expert consortium of physicians, to signal critical recovery of patients in the intervention group. Study nurses are automatically alerted and post-treatment physicians informed to intervene in case of critical PROM values. Lessons Preliminary results suggest that patients respond positively to their contact with the study nurse and that they agree with informing their physicians about critical results. We expect an intervention of every 10th patient of the study and so far, the threshold definition seems robust in the way that it is neither too specific nor sensitive. Key messages PROMs used as an intervention can promote health literacy and outcomes. Development and testing of thresholds is needed.