by Matt Batcheldor
The Vanderbilt Patient-Reported Outcomes Measurement System (VPROMS) team was recently awarded the Value-Based Health Care Primary Care Award from the Value-Based Health Care Center Europe.
VPROMS, which started at VUMC as a pilot initiative in 2019, collects patient-reported outcome measures (PROMs) via validated questionnaires that patients complete electronically in an Epic interface. Patients receive the questionnaires 72 hours prior to clinic visits and have the opportunity to complete them on a tablet given to them while waiting for appointments.
For example, in the pediatric asthma clinic, patients are asked how many asthma flareups they have had and how many times they have needed to use inhalers. The data gathered in these questionnaires is added to patients’ electronic medical records, offering objective data that can be used to track patient outcomes. The data is made available to patients, clinicians and researchers.
What began as three pilots has now expanded to more than 30 clinical sites, and patients have completed about 400,000 surveys, said Justin Bachmann, MD, MPH, medical director of Patient-Reported Outcomes Measurement.
“At the end of the day, a PROM is a clinician-patient communication aid,” Bachmann said. “It’s helping patients and clinicians connect regarding their symptoms in a standardized way. PROMs are one of the only forms of objective patient symptom information, meaning that almost all other patient history elements are being interpreted by the clinician prior to going in the chart. Symptom data from PROMs are not interpreted by anyone prior to entering the medical record. Patients answer the questions, their responses are scored by a validated protocol, and the data are immediately available for clinicians to review.”
Bachmann, a cardiologist and assistant professor of Medicine at VUMC as well as a staff physician and research scientist at the Veterans Affairs (VA) Tennessee Valley Healthcare System, said the award focuses on value-based health care delivery or endeavors that consider patient outcomes and cost. In Europe, he noted, primary care is often defined more broadly to include all aspects of outpatient care delivery, including specialty primary care.
Bachmann said that VPROMS is an enterprise-level initiative, and only a few medical centers have adopted such a strategy.
“The implementation strategies I learned as part of the VA’s Health Services Research & Development Career Development Award program helped with deploying VPROMS across the clinical enterprise,” Bachmann said.
VUMC is currently building a repository of PROM data that can be used for quality improvement and research efforts.
“I think one of the really exciting things is we’ve developed infrastructure to extract the PROM data for research and for quality improvement purposes,” he said. “We can start using machine learning and other techniques with these data to predict other outcomes such as readmissions.”
Bachmann said the VPROMS team hopes to continue to expand the initiative, eventually to measure outcomes in every outpatient setting. The data is useful for payers and for business development as well, he said.
“The ability to quantify patient health status is a very valuable thing,” he said. “This makes it possible to transparently describe outcomes alongside the costs of services that we provide.”