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We recently attended a workshop on incorporating patient feedback into the improvement of clinical care.
Advances in technology are increasing society’s expectations. Patients increasingly demand a more patient-centred service; however, healthcare providers tend not to follow this demand and avoid including patient feedback in planning and decision-making.
Possible Solutions – PROMs and PREMs.
Both Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) are measures that provide a patient-centric view of healthcare, which help to combine better clinical outcomes with improved patient satisfaction.
- PROMs are more objective and evaluate known parameters.
- PREMs are more subjective and can yield important – and unexpected – information.
Where are PROMs and PREMs being used?
These are used worldwide in a range of clinical contexts. However:
- They are not standardised,
There is often little ability to support timely reporting to clinicians, and
Data aggregation is difficult. De-identified data can be used to compare different hospitals and clinical specialties, to learn from each other and to inform quality improvement initiatives.
Why are PROMs and PREMs essential?
The consensus from diverse attendees to a recent workshop (below) was that PROMs and PREMs provide value to both clinicians and patients. Integration of PROMs enables the evaluation of patient status and the impact of their treatments, while PREMs provide patients with a voice on their own treatment. A standardised approach would enable data sharing and the ability to measure and benchmark – crucial findings that can improve the quality and efficiency of care.
PROMs and PREMs in South Australia
Anthea Hamilton, the Commission for Excellence and Innovation in Health (CEIH) Project Manager, presented a snapshot of PROMs and PREMs implementation in South Australia. The range from surveys, to research projects and registries. Reported issues and barriers include:
- A lack of medical record integration is a significant obstacle to improving the quality of care;
- There seems to be little knowledge of the validated tools, and how to access this data;
- Past efforts at implementing software solutions were blocked by governance or privacy sectors;
- Resources and technology are required to make PROMs and PREMs implementation a success;
- Reducing the manual component is essential;
- The lack of understanding of how crucial PROMs are – it falls into a ‘just get admin to do it’ mindset; and
- Internet bandwidth is an issue in regional areas.
The role of the Commission on Excellence and Innovation in Health
The Commission on Excellence and Innovation in Health (CEIH) supported stakeholder meetings during March, April and June 2020 to explore data and insights into PROMs and PREMs that have been implemented in South Australia, along with interstate models, research projects and clinical registries. A concluding workshop attempted to obtain a collective understanding on next steps for South Australia. There were 76 attendees with representatives from the Department for Health and Wellbeing, Local Health Networks (both management and clinical), consumers, the South Australian Health and Medical Research Institute (SAHMRI), Universities, CEIH staff, Advisory Committees and Clinical Networks.
PROMs and PREMs Next Steps
Initiating PROMs and PREMs at your facility will have quality, cost and satisfaction benefits. There many options for PROMs and PREMs data collection, reporting and use. Find one that suits your setting.
At a state (and national) level there is a need for a managed infrastructure for collecting and analysing data, to facilitate data sharing and to provide the ability to access data in real-time – an integrated part of clinical care.
Finally, PROMs and PREMs are only beneficial if there is proactivity about the patient’s responses. Recognising that PROMs and PREMs are vital, where patient feedback is available in real-time for both clinical and administrative decision-making, will enable the use of data to drive excellence and innovation in the healthcare system.