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Applications

Patient Reported Outcome Measures (PROMs) have been developed for a range of applications. The majority of instruments have been developed for use in clinical trials and economic evaluation but some instruments have been proposed to assist health professionals in assessing and caring for individual patients. In the wider context, instruments have been proposed for assessing the health care needs of populations.

Clinical trials and cost-utility studies

It is increasingly recognised that clinical trials should incorporate patient-reported measures of health outcome [1]. Such instruments are able to provide a standardised, quantifiable measure of benefit, upon which the outcomes of interventions can be judged. The increasing use of instruments for this application reflects the wide range of medical and surgical interventions that are aimed primarily at improving patient's well-being and quality of life rather than actually lengthening life. They are also useful in situations where interventions may produce both beneficial and harmful effects, by enabling this trade-off to be made more explicit.

When investigators need evidence for the overall value of a health care intervention in a way that permits comparisons with other interventions either within or across treatment areas, then outcomes should be expressed in the form of utilities. The most widely known form of summary value of treatments for comparative purposes is the Quality Adjusted Life Year (QALY). Within the QALY methodology the outcomes of treatment, including quality and quantity of life gains, are expressed as a single index that can be used to inform decision- making relating to the allocation of health care resources [2].

Audit and quality assurance

Patient Reported Outcome Measures (PROMs) can be routinely administered in clinical settings for assessing the effectiveness of different procedures. The information produced by instruments can guide clinicians in making decisions about different clinical inputs and for monitoring the outcomes of interventions provided by particular specialities. Unlike much audit data, patient-reported instruments focus on the outcomes of concern of patients.

Individual patient care

It has been argued that patient-reported instruments offer an important adjunct to clinicians in the care of their patients [3,4]. Self-completed questionnaires with adequate measurement properties offer a quick way for patients to provide evidence of how they view their health that can complement existing clinical evidence. Instruments applied in this context can be used to screen for health problems and to monitor the progress of health problems identified as well as the outcomes of any treatment. It has also been argued that such instruments can be used to select patients for treatment.

Population studies

It has been suggested that patient-reported instruments can be used for providing information on the health profile and health care needs of the population [5,6]. Data from such surveys, especially when accompanied by data on respondents' socio-economic status, sex, ethnicity, and age, could provide important information on the type of services needed and on whom they should be targeted. However, it is not clear that existing instruments provide the level of detail needed to assist in generating this information.

References

  1. Fitzpatrick R, Davey C, Buxton MJ, and Jones DR. Evaluating patient-based outcome measures for use in clinical trials. Health Technology Assessment 1998;2:14.
  2. Torrance GW. Measurement of health state utilities for economic appraisal: a review. Journal of Health Economics 1986;5:1-30.
  3. Tarlov AR, Ware J, Greenfield S, Nelson EC, Perrin E, Zubkoff M. The Medical Outcomes Study. An application of methods for monitoring the results of medical care. Journal of the American Medical Association 1989;262:925-30.
  4. Nelson EC, Berwick DM. The measurement of health status in clinical practice. Medical Care 1989;27:S77-90.
  5. Hunt SM, McEwen J, McKenna SP. Measuring health status: a new tool for clinicians and epidemiologists. Journal of the Royal College of General Practitioners 1985;35:185-8.
  6. Ventegodt S. Measuring the quality of life. Copenhagen:Forskningcentrets Forlag, 1996.



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