Re: Patient reported outcome measures could help transform healthcare
Nick Black points out that PROMs were initially developed for use in research, and only subsequently adopted to support clinical management of individual patients [1]. Having been an advocate of the use of PROMS in my speciality - Child and Adolescent Mental Health Services (CAMHS) - for the last decade [2, 3], I have become increasingly concerned that unless the tension between these two aims; to collect data to inform generalizable findings for audit or research on the one hand, versus the desire to collect data to inform individual care on the other, is addressed, widespread mandatory implementation of PROMS may end up harming rather than helping individual patient care.
The NHS is in the process of a major experiment in terms of rolling out a new form of monitoring – use of PROMs – but we are doing so currently without having trained people in their use with individual patients. This is being undertaken without clinicians knowing the answers to key questions such as how best to safely interpret and report the data: how often to use in clinical practice; and when not to use [4].
Whilst I and others believe there may indeed be a role for PROMs in clinical practice to help enhance collaborative working [5], this needs careful support and training [6], and a recognition upfront that we are in the early stage of our knowledge about appropriate clinical use. It is not helped by Trust imposition of measures without adequate clinician and patient input as to their utility [7], in the context of lack of appropriate IT infrastructure [8] nor by the inappropriate use of PROMs data as stand-alone measures of performance [9].
Unless we develop the evidence base as to how to use PROMs to support direct clinical work in order to find appropriate ways to integrate these tools with clinical shared decision making they may well continue to be experienced as just one more bureaucratic burden, imposed autocratically from above, and may end up doing more harm than good.
Competing interests:
I am a founding member and paid director 1 day a week of the CAMHS Outcomes Research Consortium (CORC) a not for profit learning collaboration committed to using PROMS to inform service development and have developed with colleagues a training package in the clinical use of PROMS – Using Patient Reported Outcome Measures to Improve Service Effectiveness (UPROMISE)
Rapid Response:
Re: Patient reported outcome measures could help transform healthcare
Nick Black points out that PROMs were initially developed for use in research, and only subsequently adopted to support clinical management of individual patients [1]. Having been an advocate of the use of PROMS in my speciality - Child and Adolescent Mental Health Services (CAMHS) - for the last decade [2, 3], I have become increasingly concerned that unless the tension between these two aims; to collect data to inform generalizable findings for audit or research on the one hand, versus the desire to collect data to inform individual care on the other, is addressed, widespread mandatory implementation of PROMS may end up harming rather than helping individual patient care.
The NHS is in the process of a major experiment in terms of rolling out a new form of monitoring – use of PROMs – but we are doing so currently without having trained people in their use with individual patients. This is being undertaken without clinicians knowing the answers to key questions such as how best to safely interpret and report the data: how often to use in clinical practice; and when not to use [4].
Whilst I and others believe there may indeed be a role for PROMs in clinical practice to help enhance collaborative working [5], this needs careful support and training [6], and a recognition upfront that we are in the early stage of our knowledge about appropriate clinical use. It is not helped by Trust imposition of measures without adequate clinician and patient input as to their utility [7], in the context of lack of appropriate IT infrastructure [8] nor by the inappropriate use of PROMs data as stand-alone measures of performance [9].
Unless we develop the evidence base as to how to use PROMs to support direct clinical work in order to find appropriate ways to integrate these tools with clinical shared decision making they may well continue to be experienced as just one more bureaucratic burden, imposed autocratically from above, and may end up doing more harm than good.
Competing interests: I am a founding member and paid director 1 day a week of the CAMHS Outcomes Research Consortium (CORC) a not for profit learning collaboration committed to using PROMS to inform service development and have developed with colleagues a training package in the clinical use of PROMS – Using Patient Reported Outcome Measures to Improve Service Effectiveness (UPROMISE)