Friday, February 10, 2012

Measure for measure: Patient-reported outcomes

MEASURING WHAT MATTERS: From left, Zimlichman, Mort, Meyer, Cella and Shahian

RECENT HEALTH CARE REFORM efforts have brought a shift to more value-based, patient-centered care. As a result, patient-reported outcomes are an increasingly relevant way to evaluate and measure the effectiveness of health care. On Jan. 24, the Edward P. Lawrence Center for Quality and Safety at the MGH hosted a forum on patient-reported outcomes featuring several experts from the MGH and Partners, as well as keynote speaker David Cella, PhD, principal investigator of the Statistical Center for the National Institutes of Health (NIH) Patient Reported Outcome Measurement Information System (PROMIS). PROMIS is an innovative system of assessment tools for acccurately measuring patient-reported health status.

“We need to begin measuring what matters not only to us, to Mass General or to Partners – but to our patients,” said Gregg Meyer, MD, senior vice president of the Center for Quality and Safety, who welcomed the standing-room-only crowd of attendees at the Schiff Conference Center in the Yawkey Center for Outpatient Care.

David Shahian, MD, of the Center for Quality and Safety and the Department of Surgery, introduced Cella, giving an overview of his background as a psychologist who has dedicated much of his career to studying methods of measuring patients’ quality of life, health status and overall health outcomes. In addition to his work with the NIH, Cella is chairman of the Department of Medical Social Sciences at the Northwestern University Feinberg School of Medicine.

During his presentation, “The Patient as Policymaker in an Era of Increasing Accountability,” Cella said patient-reported outcome data is important because “doing the right thing on paper doesn’t always translate into the best thing for the patient.”

He discussed some of the defects of current measurement models and described components of successful ones. According to Cella, PROMIS has been extremely effective in measuring patients’ physical, mental and social health because it uses groups of generic questions, or “item banks,” which can be interpreted in relation to specific diseases. At present, PROMIS is being tested at 15 institutions, with 40,000 patients contributing both qualitative and quantitative data. 

“These measures are really important, especially with the work we’re doing at Partners,” said Liz Mort, MD, vice president for the Center for Quality and Safety and associate chief medical officer for the MGH. She described the Partners Strategic Initiative, now in its second year, which includes numerous care redesign teams working to improve care while reducing costs. One of the challenges these teams face is effectively measuring the outcomes of their efforts and whether they increased value for patients.

The forum’s final speaker was Eyal Zimlichman, MD, MSc, lead researcher for Partners Clinical Affairs. Zimlichman focuses on incorporating new outcome measures at the Partners level as part of the Strategic Initiative, which, he said, constitutes the first attempt by a health care system to implement an operational patient-reported outcomes system. Zimlichman will begin measuring patient-reported outcomes based on the work of two care redesign teams, one focused on diabetes and the other on coronary artery bypass graft surgery. Data collection will begin in March.

For more information about PROMIS, visit For more information about the Partners Strategic Initiative, access 

Read more articles from the 2/10/12 Hotline issue.


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