‘Measuring patient-reported outcomes (PROs) is an important component of high-quality, patient-centered care, but integration of PROs into clinic can be challenging,’ says Physician Editor ‘Luckily, tools exist to help us realize this vital aspect of patient care.’
The ACR’s quality measures for care include gauging disease activity and functional status via patient-reported outcomes (PROs) and clinical assessments during routine care.1 But how do rheumatologists effectively incorporate PROs into a clinic visit?
Christie Bartels, MD, MS, chief of the Division of Rheumatology and associate professor in the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, notes that PROs are defined by the National Institutes of Health’s National Cancer Institute as “information about a patient’s health that comes directly from the patient.” Examples of PROs, under that definition include “a patient’s description of their symptoms, their satisfaction with care and how a disease or treatment affects their physical, mental, emotional, spiritual and social well-being.”2
“Many of us informally integrate patient reports in routine clinic discussions, where we know that if patients are able to participate in hobbies, like golfing or painting, that they must be feeling well. Routine PRO collection takes it a step further to say that the patient’s scaled reporting of pain, mood or quality of life (QOL), for instance, are just as important as, say, swollen or tender joint counts,” Dr. Bartels says.
PROs “can help guide treatment plans that respond to patients’ lived experiences, which can improve quality of care, adherence and outcomes,” Dr. Bartels continues. “An important set of PROs is mental and emotional well-being, including symptoms of depression or anxiety. Rheumatology literature shows these symptoms are common and often correlate with high pain scores that are out of sync with objective disease activity scores or swollen or tender joint counts, for example. Chronic disease literature shows that diagnosing and concomitantly treating depression and anxiety can improve patient disease-related outcomes and overall QOL.
“In rheumatology, recent publications show higher rates of patient-reported depression in rheumatoid arthritis (RA), psoriatic arthritis and lupus than in peers, and recently a panel of patient experts advocated screening for depression at least annually in lupus care as a proposed quality measure,” Dr. Bartels adds.
PRO Measures
Dr. Yazdany
Jinoos Yazdany, MD, MPH, chief of the Division of Rheumatology at Zuckerberg San Francisco General Hospital and the Alice Betts Endowed Professor of Medicine at the University of California, San Francisco, explains that the PRO is the outcome, such as a patient reporting poor physical function, and the patient-reported outcome measure (PROM) is the method/measure used to collect that outcome. For example, for patients with RA, clinicians may use the Multi-Dimensional Health Assessment Questionnaire (MD-HAQ) or the Patient-Reported Outcomes Measurement Information System Physical Function 10-item (PROMIS PF10a) questionnaire to assess function in a standardized way.
