PROMs & PREMs

What is Patient reported outcome measures (PROMs)?

Patient reported outcome measures (PROMs) are measurement tools (using questionnaire) through which patients provide information regarding their health status, related to their quality of life, including symptoms, conditions and also about physical, mental and social health status.

Types of PROMS

1.       Generic

2.       Condition specific

 1.    Generic PROMs: Generic prom are not specific to any particular disease or condition and are intended to make comparison between and within intervention as well as across different disease and sector of care.

Generic PROM encompasses many dimensions of life such as physical and social functioning and pain and depress

 

2.    2.    Condition specific PROMs: Condition specific prom are intended to assess the outcome that are specific and unique to particular disease and sector of care.

Condition-specific PROMs measure patient-reported outcomes in a way that is specific to a particular disease (e.g. diabetes), set of conditions (e.g. cancer), a domain (e.g. pain), an intervention (e.g. knee arthroplasty) or part of the body (e.g. eyes).

In other words we can say:

PROMs capture a person’s perception of their health.

Validated generic and disease specific tools.

Measure:

a)       Symptoms

b)      Distress / Anxiety

c)       Unmet need

 

Why collect PROMs?

Patient-reported outcomes are important to understanding whether health care services and procedures make a difference to patients’ health status and quality of life. PROMs provide insight on the effectiveness of care from the patient’s perspective.

Motive behind measuring the patient reported outcomes and experiences is that there are some aspects only a patient can report. Moreover, perspective of “outcomes of care” might differ between patients (e.g. impact on their daily role and functioning) and clinicians (e.g. focus on pathophysiology). PROMs and PREMs enable a more comprehensive understanding of outcomes and effectiveness. PROMs are essential to understand whether healthcare services and procedures make a difference to patients’ health status and quality of life.

For e.g. ‘A surgeon might report improved blood flow after a coronary bypass[clinical outcome] but this is not much if the patient reports that they still get out of breath and experience pain when they exercise’.

 

How PROMs are developed?

Ideally PROMS are Co- developed between researchers, patient and subject expert. They come up with list of possible parameters for the PROMS which are put through statistical testing to develop final list of parameter that will give the valid useful information about the patient.

 

Application of PROMS/ Advantage of PROMS?

1.       PROMs are used to allow informed choices of care providers by citizens, patients and referring physicians and to introduce competition. The patient’s choice for a particular hospital, for instance, is often a trade-off between several criteria such as waiting times, travel distance, reputation, and quality of care.

2.       Monitoring patient-reported adverse events such as pain, nausea and fatigue can be used on an aggregated level to understand which quality issues remain un- or insufficiently addressed under current practice.

3.       Bench marking of PROMs data between providers and monitoring key aspects of the quality of care they deliver is the type of information that should help providers to identify the reasons for their performance, and then to identify what they need to do in order to improve.

4.       PROMs and PREMs could also be used in the context of accreditation programs or quality inspections.

Examples of PROMs

Quality of life          -             e.g.         EQ-5D, AQoL

Symptoms                -            e.g.         Pain ( NPRS) , Fatigue (FSS)

Distress                    -            e.g.         Depression (K10  PHQ2), Anxiety (GAD7)

Functional ability    -             e.g.         WHO DAS 2.0

Self-efficacy            -             e.g.         GSE

 

Sample questionnaire of PROM tool

1.      EQ 5D- 5L                                                                               :          Download

2.      Hip injury and Osteoarthritis outcome score (HOOS)            :           Download

3.      Knee injury and Osteoarthritis outcome score (KOOS)          :           Download

 

 What is Patient reported experience measure PREM?

Patient reported experience measure are the measuring tool which used to obtain patient view and observation on the aspect of health care services they have received. This include accessibility and physical environment of the services.

PREM is a measure of a patient's perception of their personal experience of the healthcare they have received. PREM instruments should focus on the aspects of the care that matter to the patient care.

PREM results can be used to improve services and provide a patient view on quality improvements.

Types of PREMS

1.       Relational (Measures patients’ experience of their relationship to treatment).

2.       Functional (Examine practical issues, facilities available).

 

 Examples of PREMs Instances

1.       Time spent waiting

2.       Access to and ability to navigate services

3.       Involvement (consumer and carer) in decision-making

4.       Knowledge of care plan and pathways

5.       Quality of communication

6.       Support to manage long-term condition

7.       Would they recommend the service to family and friends

Examples of PREMs Questionnaire

1.       Capture a person’s perception of their experience with health care or service.

2.       Various indicators included in validated surveys/ questionnaires e.g. CAHPS (US)

3.       Newer attempts to measure integrated care e.g. Singer, Picker Institute Europe

 

Dimensions of PREMs

The most commonly researched approaches for measuring patient and carer experience include surveys, interviews and patient stories.

 

How to do measure Patient experience

Approaches can be divided according to the depth of information they provide and the extent to which they collect information that may be generalize to a wider population. In selecting an appropriate measurement approach, it may be necessary to weigh up the importance of depth versus generalization or combination of both.

https://www.health.org.uk/sites/default/files/MeasuringPatientExperience.pdf

When to collect the Patient reported experienced questionnaire

PROMs and PREMs Questionnaires can be collected from the patients

1.      at the point of initial contact,

2.      Postoperative form being posted to each individual participating in the data collection

3.      The data should be collected at a pre-specified time point in relation to the event or disease being studied. 

4.      The optimal timing to complete the questionnaire will vary with each disease and procedure.

PROMs and PREMs can be distributed via email, telephone calls, and more recently text messages, giving instant feedback on patient care. Online surveys and face-to-face interviews can also be used to collect data

 

Why to measure Patient reported experience?

1.      To improve Care of Patient

2.      To increase patient loyalty

3.      To increase better financial benefits

4.      To decrease patient dissatisfaction

5.      To decrease malpractices

 

Sample questionnaire  of PREM tool

1.    CARE Patient Feedback Measure form : Download 

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