JAMA Viewpoint: Incorporating Health Status into Routine Care
Understanding patient-reported health status (including symptoms, functional status, and health-related quality of life) is central to healthcare value, defined as patient outcomes relative to the costs of care. Elective percutaneous coronary intervention (PCI) for stable ischemic heart disease serves as a prototypical example. Although the purpose of elective PCI is to reduce patients' symptoms and improve angina-related quality of life, the improvement in patients' health status from these procedures using standardized performance measures is not routinely quantified in clinical practice, which limits the ability to define their value. This article describes the early efforts of VA's Patient Reported Health Status Assessment (PROST) system to capture, report, and initiate clinical action in response to patient-reported health status measures, thereby improving the value of care delivered to Veterans undergoing elective PCI.
The VA Clinical Assessment Reporting and Tracking (CART) Program uses a software application embedded within VA's electronic health record to collect patient and procedural data at the point of care for all PCIs performed in VA. To enhance the program, CART has started to capture patient-reported health status measures through the PROST system, which was designed to address some of the challenges inherent in collecting patient-reported health status data. For example, rather than depending on clinician administration of health status surveys, PROST uses an interactive voice response (IVR) system to administer, capture, and score disease-specific health status surveys via telephone. The integration of PROST into the CART Program also facilitates the longitudinal capture of patient-reported health status data to better define the improvements patients experience after treatment. At the completion of a PCI procedure documented in CART, the IVR system is triggered to automatically call patients and administer disease-specific health status surveys at one and six months post-PCI. Although patient acceptance of the PROST IVR telephone system is high (in pilot testing of 50 Veterans, 96% had a favorable opinion of the system), this may change as patients become more familiar with other approaches to patient engagement (e.g., text, mobile apps). Accordingly, additional platforms for capturing health status using these technologies will need to be developed.
- Performance measures largely focus on care processes that are often weakly linked to patient outcomes.
- Refocusing performance measures on health outcomes that reflect the patient's perspective may reduce measurement burden and incentivize care delivery improvements that directly improve patient health.
- Integrating data from patient-reported health status measures such as PROST could lead to efficient and targeted interventions for specific patient populations.
This study was funded by VA HSR&D's Quality Enhancement Research Initiative (QUERI), and Dr. Bradley was supported by an HSR&D Career Development Award. Drs. Bradley and Ho are part of HSR&D's Center of Innovation for Veteran-Centered and Value-Driven Care in Denver, CO.
Bradley S, Rumsfeld J, and Ho PM. Incorporating Health Status in Routine Care to Improve Health Care Value: The VA Patient Reported Health Status Assessment (PROST) System. JAMA, Viewpoint. August 2, 2016;316(5):487-88.