Do patient reported outcome measures do more harm than good?BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2669 (Published 01 May 2013) Cite this as: BMJ 2013;346:f2669
- Miranda Wolpert, Director, CAMHS Evidence Based Practice Unit (EBPU)1
Black points out that patient reported outcome measures (PROMs) were developed for use in research and subsequently adopted to support clinical management.1 I have advocated the use of these measures in Child and Adolescent Mental Health Services (CAMHS) for the past decade (www.corc.uk.net). However, I have become increasingly worried that unless the tension between the two aims of data collection (informing generalisable findings v informing individual care) is resolved, widespread mandatory implementation of PROMs may harm rather than help individual patient care.
The NHS is currently rolling out a new form of monitoring with the use of PROMs, but without training people in the use of these data in individual patients. Clinicians do not know the answers to key questions, including how best to safely interpret and report the data, how often to use these data in clinical practice, and when not to use them.2
Although PROMs may have a role in clinical practice to help enhance collaborative working,3 this needs careful support and training, and recognition that we are in the early stage of our knowledge about appropriate clinical use.4 The situation is not helped by trusts imposing measures without adequate input from clinicians and patients on the usefulness of these measures, the lack of appropriate information technology infrastructure, or the inappropriate use of PROMs data as stand alone measures of performance.
Unless we develop the evidence base on how to use PROMs in direct clinical work they may continue to be just one more bureaucratic burden and may end up doing more harm than good.
Cite this as: BMJ 2013;346:f2669
Competing interests: MW is a founding member and paid director (one day a week) of the CAMHS Outcomes Research Consortium (CORC), a not-for-profit learning collaboration committed to using PROMs to inform service development. She has developed with colleagues a training package in the clinical use of PROMs—Using Patient Reported Outcome Measures to Improve Service Effectiveness (UPROMISE).