PROMising Steps in
|Neil Wagle, MD, MBA|
It's PROM time at BWH-not the kind of prom a high school
student anticipates, but a new step forward in efforts across Partners to
redesign care. The collection of PROMs, or patient-reported outcomes measures,
is underway at several BWH practices as a way to improve patient care.
"We track adverse events, readmissions and mortality," said
Neil Wagle, MD, MBA, the Partners HealthCare medical director for PROMs. "But
we don't do a good job of tracking all the outcomes that matter to our
Such meaningful outcomes might include whether a patient can
climb stairs without feeling pain, lie down without becoming short of breath or
feel well enough to go out and socialize. "When we measure these things, we can
start to figure out how we can improve our patients' quality of life," Wagle
Health care leaders have been discussing such measures for
decades, but the logistical challenge of collecting and sharing this kind of
information has always prevented it. To make the information meaningful, it
must be made available to multiple care providers who can intervene in a
patient's health and, on a broader scale, use it to build population data.
The PROMs initiative is rolling out across Partners, with
several practices at BWH and MGH in the pilot stages for diabetes patients and
patients undergoing coronary artery bypass graft (CABG) surgery. According to
Wagle, no other organization has collected PROMs on such a large scale or
systematic way as Partners aims to through the care redesign initiative.
Ultimately, the program aims to achieve the following
through data collection and sharing:
For individual care providers to improve the
health of individual patients
For population data to improve patient
engagement and facilitate better medical decision making.
For researchers and population managers to find
answers to general health questions
"This is an exciting time for primary care to develop new
methods and models to improve care and patient outcomes," said Asaf Bitton, MD,
assistant medical director of Brigham and Women's Advanced Primary Care
Associates at South Huntington, one of the practices piloting PROMs. "We're
optimistic that this could provide a novel platform to tell us how people are
functioning so we have an opportunity to intervene and improve care that
matters most to them."
A new international collaborative will begin in Boston, centered around the
Partners PROMs project, said Wagle. The collaborative will focus on getting
other institutions around the world to collect patient reported outcomes
measures and measure them in the same way, so there is meaningful data to
compare across institutions.
How it Works
A medical assistant hands the patient an iPad in the waiting room. The patient
receives a short explanation of the PROM project and then answers 15 questions
about how he or she feels, ranging from their pain level to a question about
their social relationships-if they feel well enough to socialize with friends
and family, for example.
The process concludes with a question about how the patient
would like to receive follow-up communication, whether by e-mail or phone.
Every six months, the patient receives a follow-up questionnaire. (The interval
varies depending on the condition; diabetes patients receive follow up every
six months, but CABG patients receive it every three.)
"This status report is a good tool for care providers to
have," Wagle said.
PROMs may work especially well in a medical home model,
where providers can quickly assess a patient's decline in mental health, for
example, and connect the patient with a social worker or behavioral health
"It's very patient-centered," said Sonia Freitas, PharmD,
project lead for PROMs at South Huntington, which focuses on diabetes patients.
"Patients may have their diabetes under control but may not be feeling healthy
or well overall. PROMs can help clinicians to address the issues that are most
important to patients-those that may be preventing patients from meeting their
In November, the first of the PROMs reports will be
available for care providers on LMR. In addition to South Huntington, diabetes
patients at Brigham Circle Medical Associates and Brigham and Women's Primary
Care Associates at Newton Corner are also part of the pilot. The BWH Watkins
Clinic and the MGH Cox Clinic are piloting PROMs for CABG patients.
"Collecting this information opens up a new domain of
measuring patients' experience of care with us," said Bitton. "It will help us
be more responsive to their needs, and it will help our providers to consider
how our treatments are impacting patients' lives-or not."
PROMs on the Horizon
Next year, the program will expand to multiple other conditions, possibly
including total knee replacement patients. "Patients have knee replacement
surgery because they have pain and can't walk," Wagle said. "But we don't systematically
track these symptoms when they leave, so we don't measurably know if they walk
better or have less pain."
It will also expand to three more practices across Partners
for diabetes patients, as well as CABG patients, and later include stroke patients
and urology patients, among others, across several Partners hospitals.
This type of data is not only useful to care providers, but
also to patients considering certain procedures, such as a total knee
replacement. The ability to look at data from others who have had the surgery
may better inform their own decisions.