The Vanderbilt Patient-Reported Outcomes Measurement System (VPROMS) has collected its millionth patient-reported outcome measure (PROM), or pre-appointment survey that patients complete about their health, making it one of the largest collections of such surveys in the United States.
VPROMS is supported by Vanderbilt University Medical Center’s Office of Population Health under David Posch, Executive Vice President for Population Health.
“VPROMS is a critical part of the Office of Population Health’s efforts at care delivery transformation,” said Posch. “These measures help us improve the quality of life and outcomes of VUMC’s patients.”
The program was launched as a pilot initiative in 2019 by Justin Bachmann, MD, MPH, a cardiologist and medical director of Patient-Reported Outcomes Measurement. The VPROMS team also includes Emily Burnell, Reagan Buie and Emma Barnes.
“We’re out on the forefront with VPROMS,” Bachmann said. “Every U.S. medical center likely has some sort of isolated PROM collection effort in one or more clinics, and they may have a depression-screening questionnaire, but very few medical centers have launched institutional initiatives such as ours to collect these data.”
VPROMS provides a critical tool to help determine whether clinicians are improving patients’ health. PROMs document a patient’s self-reported health status at a specific point in time. Unlike performance measures, which capture providers’ productivity and adherence to standards of care, or patient experience measures, which focus on care delivery, PROMs attempt to capture whether the services provided positively impact patients’ health and sense of well-being. For example, in a PROM survey, patients might be asked to assess their general health, mood, pain and ability to complete various activities.
Patients receive a patient-reported outcome measure (PROM) survey 72 hours before a clinic visit through My Health at Vanderbilt, VUMC’s online patient portal. They can also complete the survey on a tablet provided at the clinic while they wait for an appointment. VPROMS collaborated closely with the VUMC Paperless Clinic initiative led by Janice Smith, RN, MEd, Vice President for Adult Ambulatory Operations.
“At its core, VPROMS is a clinician-patient communications tool,” Bachmann said. “It’s an effort by the Medical Center to listen to patients more effectively. PROMs are really one of the only objective forms of symptomatic data because everything else is interpreted by the clinician and put into the chart. This is a way to cut through that and find out how the patient is actually feeling.”
The data gathered in the questionnaire is added to a patient’s electronic health record (EHR) and is available to patients, clinicians and researchers. When a health care provider accesses a patient’s PROM data in their EHR, if multiple surveys have been completed, a trend over time can be observed.
“One of the real advantages of collecting PROM data is that it gives you a better sense of symptoms over time,” Bachmann said. “How were they feeling two weeks ago, four weeks ago, eight weeks ago? You can clearly see trends.”
A remarkable illustration of the impact of a clinical practice on patient quality of life is the comparison of the PROMs data collected from patients before and after having bariatric or weight-loss surgery at VUMC. The PROM records a 0-100 score for several patient-reported factors related to their mental, social and physical wellbeing. Before the bariatric procedure, the average score was approximately 40. A year out from surgery, that same measure is over 80, “so the quality of life has essentially doubled for those patients,” Bachmann said.
What began as a pilot project at three clinical sites has expanded to more than 30 clinical sites and can be added to any clinical site that runs eStar, VUMC’s Epic-based EHR, said Bachmann. PROM completion became an Enterprise Pillar Goal for fiscal year 2023. Thus far, 61% of patients assigned a PROM survey before a clinical visit completed the survey, exceeding the goal of 60%.
“Implementing PROMs and moving this effort from three pilots to a Pillar Goal required working with many, many people in the clinical enterprise,” Bachmann said. “VPROMS wouldn’t have been possible without the hard work of Emily, Reagan, Emma and support from David Posch through the Office of Population Health. Dr. Bill Stead, who was Chief Strategy Officer at VPROMS’ inception, mentored me while we launched this endeavor. The support of executive leadership, including Dr. Jeff Balser, Dr. Wright Pinson and Dr. Jennifer Pietenpol, has also been critical.”
Approximately 85% of patients complete their PROM surveys before arriving at their outpatient appointment, and just 15% complete the surveys on tablets provided in the waiting room. This is a reversal from the program’s launch, Bachmann said. Most of the patients completing PROMs are between the ages of 61 and 70.
“A lot of clinical sites initially had concerns that these questionnaires might slow down the clinical workflow, but that hasn’t proven to be the case,” Bachmann said. “The average amount of time to fill out these questionnaires is about seven minutes.”
Just as VUMC’s BioVU, the world’s largest DNA biobank based at an academic institution, has proven to be an invaluable resource for research, the VPROMS data repository, with a million and counting records, is a rich resource for investigations related to patient care. Already, more than $2 million in grant funding has been awarded to support Medical Center research associated with VPROMS data, and that is expected to grow.
For example, Bachmann is the principal investigator for a just-completed multicenter Patient-Centered Outcomes Research Institute (PCORI) study in which a standardized PROM for patients with heart failure was implemented. The PROM data from three medical centers was then uploaded to PCORnet, a secure national database of patient information from multiple healthcare systems, to test ways to use the data to improve patient care.
Bachmann and his team have worked with closely with Allison McCoy, PhD, director of the Vanderbilt Clinical Informatics Core, to develop ways to efficiently pull out VPROMS data to support investigations, and VUMC clinical teams can reach out to their groups for assistance.
“The ability to leverage PROM data is something that distinguishes us from other academic health systems and large hospital systems, and it’s due to VUMC’s historical strength in biomedical informatics, as well as our excellent relationship with Epic. Epic has very good tools for extracting data from the electronic health record.”
Jeff Balser, MD, PhD, President and CEO of VUMC, led a session presenting VPROMS’ work at the International Consortium for Health Outcomes Measurement meeting in Boston in November 2022. Titled “Keys to Successful Value-Based Health Care Implementation — Pioneers’ Insights,” the session detailed VUMC’s efforts to make the measurement of outcomes that matter most to patients a part of routine clinical care.
The VPROMS group has also developed online patient-facing information called MyHealth Snapshot to explain PROMs to patients and patient families and how completing the surveys can improve care. Learn more: https://www.vanderbilthealth.com/information/myhealth-snapshot.
