Editor’s Note: Congratulations to the PROMIS Team at the University of Rochester in New York for their work on the UR VOICE program. For this patient-reported outcomes program, which has gathered more than one million scores to date, they were award a Sherman Award for Excellence in Patient Engagement at the National Patient Safety Foundation’s Patient Safety Congress in May 2017. The Sherman Award is co-sponsored by Taylor Healthcare and the Lucian Leape Institute at NPSF.
Back in the late 1970s, at the University of Rochester, Drs. George Engel and John Romano developed a novel approach to clinical medicine that emphasized the importance of understanding human health and illness beyond a simple biological problem. The biopsychosocial model encourages the health practitioner to look at the interactions between a person’s genetic makeup (biological), mental health (psychological) and social factors to determine the cause and course of health-related outcomes.
Expanding the scope of factors that influence overall health meant that health practitioners had to look beyond the obvious symptom of a broken leg, for example, and explore how their patient would cope with the temporary disability and what other supports they had at their disposal. In this model “How are you doing?” becomes as important to ask as “Where does it hurt?”
Platform for Patient-Reported Outcomes in Research and Practice
At the University of Rochester Medical Center (URMC), we have fully embraced the biopsychosocial model and are in the middle of a multi-year project to further engage our patients so they can provide important information that can assist in their care. UR VOICE (Validated Outcomes in Clinical Experience) is a patient-reported outcomes platform developed at URMC that is used by 550 physicians in 30 clinical programs at URMC. The PROMIS (Patient-Reported Outcomes Measurement System) works with UR VOICE to capture important indicators of health, including physical function, mood, and pain level. PROMIS was developed at Northwestern University as part of a National Institutes of Health initiative to create a tool to capture patient perspectives on their medical care and has been validated with state-of-the-science methods.
While PROMIS was originally used primarily for research, URMC recognized its potential to move the bar toward increasing the patient-centeredness of their healthcare. Bringing this tool out of the research lab and into the clinical arena, as standard of care, allows us to engage patients at each outpatient visit so we can measure their progress in real time, at every patient-provider interaction, throughout the course of their care and throughout our healthcare system. We are also gratified that colleagues from institutions around the world have benchmarked UR VOICE as they look to harness the power of PROMIS assessments in their patient care.
Over many months, our team worked to develop an efficient and effective method to collect PROMIS assessments using the UR VOICE platform. We tried several different approaches in some of URMC’s busiest outpatient clinics, such as orthopaedic surgery, which sees 17,000 patients a month, and invited patients, providers and staff to provide feedback on the system. Ultimately, we found that using the registration staff to launch the system as a patient checks in for their outpatient appointment made the most sense. We use an easily recognizable technology—the iPad—for the PROMIS collections. The scores are sent directly to the electronic medical record so they are available before, during and after the patient’s encounter with their provider.
Data Is Equally Useful to Patients and Providers
We wanted the data to be useful for patients as well as for their caregivers, so we built a user interface that generates line charts to show how patients progress over the course of their treatment. Providers can view the graphs before entering the clinic room, and we have found that showing patients a visual of their progress during their clinic visit is a powerful tool to engage them in their care.
The following video demonstration shows the UR VOICE system in action in the clinic:
Not only is the data used for shared decision-making between a provider and an individual patient, collectively, this patient-reported-outcome information will help providers assess their work, link patient expectations with predictable outcomes and assist in the development of new ways to improve outcomes. There is also benefit at the level of population health management as this data is yielding important information that will help URMC deliver the highest quality care in the most cost-efficient way. To improve value, we must improve outcomes, and being able to measure outcomes from the patient’s perspective is highly important to our efforts.
PROMIS collections began in the department of orthopaedics in February 2015, and as word spread throughout the medical center, other programs have asked to adopt it for their patients. Because of our ambitious goal of collecting this important information at every outpatient visit and across medical specialties, we have collected more than ONE MILLION PROMIS scores on 143,984 URMC patients to date!
It is an honor to be one of the two 2017 recipients of the Sherman Award, which recognized how this innovative program engages our patients and allows them to be active participants in their care.
We are grateful to our URMC colleagues and leadership for their support in this mission, to the URMC Clinical Innovations Team for their work on UR VOICE, to Northwestern for its continuing development of PROMIS and most of all, to our patients. By embracing this change in their care experience, and generously sharing vital insight into their bio- psycho- and social well-being, our patients are helping URMC change care and improve outcomes.