Importance of patient reported outcomes Flashcards
Cancer Survivorship
By 2030, it is projected that over 3 million people will be living with a cancer diagnosis nationally.
“The health and life of a person with cancer post treatment until end of life. It covers the physical, psychosocial, and economic issues of cancer, beyond the diagnosis and treatment phases. Survivorship includes issues related to the ability to get healthcare and follow-up treatment, late effects of treatment, second cancers, and quality of life”. (National Cancer Institute)
Medical and Psychosocial concerns of cancer patients
Report defined conceptual quality of life model with four domains:
- physical well-being
- psychological well-being
-social well-being
-spiritual well-being
Four essential components of survivorship care
- prevention of recurrent and new cancers, and of other late effects*
- surveillance forcancer spread, recurrence, or second cancers and assessment of medical and psychosocial late effects*
- intervention for the consequences of cancer and its treatment*
- coordination between specialists and primary-care providers to ensure that all of the survivor’s health needs are met*
How many cancer patients and survivors actually have physical, psychological, informational and supportive care needs that are met within the healthcare systems?
Evidence suggests under 2/3rds
Why is outcome measurement important?
- New strategy has emerged in healthcare: “achieving the best outcomes for the lowest cost and thus maximising value for patients”.
- Concept of value-based healthcare.
- The only true measure of quality are the outcomes that matter to patients.
- Value is created by improving the outcomes of patients with a particular clinical condition over the full cycle of care.
Value based healthcare (VBHC)
- Innovative model which is being implemented across various healthcare systems.
- Aims to promote the continuous improvement of healthcare systems through outcome assessment for a given level of cost.
- This approach signifies a shift in healthcare towards a patient-centred system organised around the patient’s needs.
Improving value requires either:
Improving one or more outcomes without increasing costs.
OR
Lowering costs without negatively affecting outcomes.
This approach signifies a shift in healthcare towards a patient-centred system organised around the patient’s needs.
Clinical outcome assessment (COA)
Tools or instruments used to evaluate the impact of a medical intervention or treatment on patients’ symptoms, functioning, health-related quality of life and overall well-being.
Refers to the measurement of a patient’s health status or treatment response based on their own perceptions, observations, or reports.
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It is the overall results that matter, not the outcome of an intervention or a single visit or care episode.
Example: if a surgery is performed flawlessly but the patient develops post-operative infection, then the outcomes would be negatively affected and the costs of care would increase.
4 types of Clinical Outcome Assessments (COAs)
1.Clinician-reported outcome measures (ClinROs)
2.Observer-reported outcome measures (ObsROs)
3.Performance outcome measures (PerfOs)
4.Patient-reported outcome measures (PROMs)
ClinROs (definition + example) aka Clinician-reported outcome measures
Evaluations or assessments of patient health status, symptoms, functional abilities etc that are completed by healthcare professionals.
Based on the observations and clinical judgements of the healthcare professionals.
Examples:
Karnofsky Performance Status Scale
Hamilton Rating Scale for Depression
ClinROs key characteristics
Rely on the clinical judgement and expertise of healthcare professionals.
Can include both objective and subjective measures:
- Objective measures: vital signs, laboratory results
- Subjective measures: clinician-rated pain, depression, etc based on interactions with patients.
Usually use standardised assessment tools, clinical guidelines etc to ensure consistency and reliability.
Typically conducted in context of clinical care – during ward rounds, routine follow-up appointments, medical examinations.
ObsROs (definiton + example) aka Observer-reported outcome measures
Assessments of patient health status, behaviour or functioning, that are completed by individuals who observe the patient’s behaviour or activities.
Assessment made by:
caregivers
family members
trained observers
–> those with regular contact with the patient and can provide insight into the patient condition
Example:
Behavioural Assessment Scale for Children
Key characteristics of ObsROs
Involve the observation and documentation of a patient’s behaviour, symptoms or functional abilities by individuals with direct contact or interaction with patients.
Allow third party perspective on aspects of a patient condition that may not be apparent to the patient themselves.
Objective and subjective components:
- Objective: physical signs, behavioural observations.
- Subjective: caregiver related pain intensity etc.
PerfOs (definition + example) aka Performance outcome measures
Assessments used to evaluate a patient’s ability to complete specific tasks or activities related to their health status or functional abilities.
Involve objective evaluations of a patient’s performance, conducted by HCPs, caregivers or trained assessors.
Examples:
* Timed up and go tests
* Grip strength tests
* Balance assessments
Key characteristics of PerfOs
Task or activity based – assess a patient’s ability to complete specific tasks, activities or functional tests relevant to their health condition or treatment goals.
Objective evaluation – involve direct observation or measurement of patient’s performance by trained assessors using standardised protocols, scoring criteria or assessment tools.
Functional assessment – focus on assessing functional abilities such as mobility, cognitive function, balance, strength, coordination, communication etc.
