Patient Reported Outcome Measures (PROMs)
By measuring and analyzing the subjectively perceived success of treatment, we can constantly optimize the quality of our treatment.
Do our patients perceive the treatment as successful? By measuring and analyzing this, we continuously improve the quality of our treatment.
Patient Reported Outcome Measures (PROMs) aim to improve the quality of treatment and focus on the patients.
PROMs are sets of questionnaires that specifically address the respective disease. This makes it possible to measure quality of life and health status in a long-term and standardized manner.
The survey is completely digitalized. This means that the individual details and the resulting findings are available to medical staff in real time. This allows them to react promptly to changes in the patient's state of health and quality of life. The data can also be analyzed for patient groups - for example, to compare different treatment methods. The aim is to generate added value for our patients in line with the USB "Value Based Healthcare" strategy.
In 2022, the USB took a further step towards value-based healthcare with two innovative collaborations with health insurers and partner hospitals.
The current remuneration system based on flat rates per case offers false incentives. This means that hospitals earn more the more cases they treat. The quality of treatment is not reflected in the flat rate per case.
The inclusion of quality indicators (e.g. PROMs) is intended to counteract this. The primary aim is to remunerate the quality provided and not just the quantity. The aim is to prevent unnecessary interventions and achieve the best possible treatment outcome. PROMs are a central component of this, as they allow the success of treatment to be measured over the long term and therefore provide an indication of the necessity of the intervention. They also allow early detection of any deterioration in the subjectively perceived state of health.
PROMs: A patient's experience
What are patients' experiences with Patient Reported Outcome Measures (PROMs)? How is the survey perceived? A breast surgery patient who was treated for breast cancer at the University Hospital Basel gives us an insight.
"When I filled out the questionnaire for the first time, I was amazed at the sometimes intimate questions that were asked. (...) But after the second or third time, you get used to it. It can perhaps happen that patients find it too intimate. But I think you (...) don't have to be ashamed. The interviews can help (...). (...) at first you're shocked anyway that you're ill and how ill. And then comes the interview and you've never been confronted with such an intimate interview before. And over time you understand why the questions are being asked. Because after a while you understand exactly what they mean, because you can understand it. (...) When you're in the middle of it, you just work. (...) It's only with time that the questions take on depth, i.e. meaning."
"(...) the professionals have a very broad knowledge (....) But nevertheless, the questioning they do (editor's note: this refers to PROMs) is also a bit different. It is more personal. So you can also discuss it. For example, if something doesn't improve, what's the reason and so on."
How is PROM data used? - Examples from practice
Further information on the projects with regard to remuneration models can be found here:
Further information on the implementation and use of PROMs can be found here:
Use and benefits of PROMs
- at an individual level in patient contact
- at a collective level as a quality indicator
- as a building block in the development of quality-based remuneration models
The Clinic for Orthopaedics and Traumatology records PROMs for:
- Patients with planned orthopaedic surgery on the hip, knee, foot and shoulder
- Traumatology patients who require surgical treatment due to a bone injury ("fracture") of the upper and/or lower limb(s)
- Patients with a musculoskeletal infection
The examples (Fig. 1 and 2) show the improvement in the physical functioning of patients who have received a joint replacement by means of a prosthesis due to their hip or knee complaints.
The KOOS-PS (KOOS-PS: Knee injury and Osteoarthritis Outcome Score-Physical Function Short Forms) (for knee patients) and HOOS-PS (HOOS-PS: Hip Disability and Osteoarthritis Outcome Score Physical Function Short Forms) (for hip patients) measure the extent of the subjectively perceived difficulties that patients experience due to their hip or knee complaints. The score can have a value between 0 and 100, with a higher value indicating greater difficulties (see: http://koos.nu/).
In order to measure the success of the treatment, the initial survey is carried out at the USB before the planned hip or knee surgery. This is followed by further postoperative surveys at defined times after the treatment:
- six weeks postoperatively
- three months postoperatively
- six months postoperatively (only for knee patients)
- one year postoperatively
Fig. 1: KOOS-PS score, internal data analysis
Fig. 2: HOOS-PS score, internal data analysis
The gastroenterology department at Clarunis - University Abdominal Center Basel (USB site) - systematically records PROMs for patients receiving infusion therapy for chronic inflammatory bowel disease (IBD).
Patients receive infusion therapy approximately every six to eight weeks and answer the IBD control questionnaire. This records the extent of disease control based on various areas:
- Disease activity
- Change in bowel symptoms
- Symptoms of the disease
- the need to discuss treatment options, symptoms and side effects with the attending physician
The score can have a value between 0 and 16, with a higher value indicating better control of the bowel disease. The aim of treating chronically ill patients is to keep disease activity low and disease control as high and stable as possible.
As the majority of patients had already received infusion therapy when PROMs was introduced for IBD, the first survey does not necessarily reflect the start of therapy. It can be observed that the value remains stable in the patients and increases over time. Patients also have the opportunity to indicate whether they find the current treatment of their disease helpful. If necessary, this information can be used to respond promptly to various aspects of the illness. The graph shows that patients find the current treatment helpful.
Fig. 3: IBD Control 8 score, internal data analysis
Fig. 4: Question from the IBD control questionnaire, internal data analysis
Pain Medicine treats patients with acute and/or chronic pain. PROMs are currently being recorded for patients with back pain who have received infiltration therapy.
Immediately before the therapy, they are asked, among other things, about the intensity of the pain in their back, which is to be classified on a numerical pain scale between 0 (no pain) and 10 (worst pain imaginable). This survey is repeated seven days, one month and three months after the infiltration.
There is a significant, on average approx. 30%, clinically and statistically significant reduction in back pain as a result of the infiltration and this remains at a stable level. At the same time, the patients' quality of life increases.
When interpreting the data, it is important to note that 52% of patients had back pain for more than one year before the infiltration and 38% of them had back pain for more than two years, meaning that this was not a spontaneous improvement.
Fig. 5: Numerical pain scale, internal data evaluation
Fig. 6: EQ-5D-5L, internal data evaluation
At the Sarcoma Center, patients with a sarcoma are included in the PROMs survey.
Fig. 7: Toronto Extremity Salvage Score: Physical Function
The survey dates are:
- baseline
- after completion of neoadjuvant therapy (if performed)
- six weeks postoperatively
- three months postoperatively
- six months postoperatively
- one year postoperative
Various aspects were discussed in the survey, including the physical function of the affected extremity using the TESS questionnaire (Toronto Extremity Salvage Score).
Patients with sarcoma can experience physical impairments as a result of treatment; the TESS measures the severity of the subjectively perceived physical limitation. It has been shown that one year after the start of treatment, patients have regained their original functional capacity or even show slightly improved values.
PROMs for patients with small cell and non-small cell lung cancer and pleural mesothelioma are admitted to the Lung Tumor Center. The initial consultation takes place before the start of treatment.
The follow-up surveys take place three and six months after the start of treatment and then annually. Among other things, the patients complete the EORTC-QLQ-C30, a generic oncological questionnaire that measures the quality of life of patients with a tumor disease (see: Aaronson NK et al. The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute 1993; 85: 365-376).
Various subscores can be calculated from this, including the state of health and general attitude to life. It can be seen, for example, that patients with stage I lung cancer have a stable to slightly improved quality of life after treatment (Fig. 8).
Fig. 8: EORTC-QLQ-C-30 quality of life score, internal data analysis
Fig. 8: EORTC-QLQ-C-30 quality of life score, internal data analysis