Use PROs in Quality

  • PROs in Quality

    PROs are being added as outcome measures to quality programs from payers and regulatory agencies. Therefore, some additional considerations will help ensure your data accurately reflect your practice when used to measure performance across healthcare systems.

    Ensure complete and consistent PRO data to minimize bias.

    • Consult quality improvement/regulatory guidance on PRO measures, required time frames, population definitions, and pre/post assessment requirements.

    • Ensure that the PRO measure selection, patient population criteria, and time intervals for collection match the external expectations.

    • Maximize data capture for stable estimates of quality. The International Society of Arthroplasty Registries recommends 60% completion of pre- and post-operative PROs. Following our Implementing PRO Collection process can help you achieve this.

  • • CMS and other payers specify if administrative codes (e.g., ICD10, CPT) and/or clinical and demographic variables (e.g., age, sex, BMI, smoking) are used when risk adjusting outcome data. These can be added to a survey instrument if not readily available from the electronic health record.

    • Review the regulatory documents for key metrics. For example, CMS offers guidance for patient-reported risk measures to be collected and reported with PROs within their Comprehensive Care for Joint Replacement Model (section III.D.3.a of the CJR final rule and 42 CFR § 510.400(b)).

    • Registries used for quality reporting may also have specific data capture requirements for risk adjustment.

    We have included a planning tool you can use for using PROs in quality programs in our PRO Implementation Workbook.

The team you have assembled should participate in monitoring PRO data to ensure the processes you have implemented are working and the desired outcomes are achieved. The following table outlines the role of each member and the data each should monitor.

 

Information Technology (IT)

  • Assess the established technology enhancements required to support workflows for collection and use.

  • Volume and scoring data to evaluate whether the e- system is working properly.

Practice Administrator

  • Support the implementation by assigning necessary resources and promoting a culture that embraces the changes necessary for PRO collection and reporting.

  • PROs completed at critical timepoints, such as baseline and post-treatment; quality outcomes, such as improvement in pain and function.

Clinicians

  • Advise the team on appropriate PRO selection and timing, advocate for adoption, and use the PRO with patients.

  • Individual patient results to use for clinical treatment decisions; quality outcomes, such as improvement in pain and function; feedback on use rate.

Patients

  • Provide input into reports used for clinical care and suggest procedures to enhance response rates.

  • Individualized data, presented in an understandable format.

Office staff

  • Implement a smooth office workflow for collection of the PRO and sharing with clinicians and patients.

  • Patients who have not completed the PRO, for outreach efforts; patients with a completed PRO who have an appointment today, for distribution of results to patients and clinicians.