PROMs in Practise

As life expectancy rises and clinical investigations and treatments get ever more effective and complex, expectations of what health systems should deliver in terms of keeping people healthy for longer are, rightly, growing. However, the longstanding challenges of wide variation in access and quality, even within a single system, and spiralling costs are putting an ever greater strain on health systems and pose a risk to continued progress.

Today, healthcare quality is mainly understood in terms of process measures, such as waiting times, length of stay, and discharge rates as well as the unintended consequences or complications of care, such as hospital acquired infections and mortality. These measures are clearly important and need to be measured and managed, but they do not help patients or clinicians understand the actual results of care from the perspective of the patient. This includes information about which patients get better or worse or in what circumstances treatment is successful, whether it is generally done at the right time by a particular doctor or hospital and, if not, why not, how long the benefits last or the relative successes between treatments, doctors, and hospitals. The International Consortium of Health Outcomes Measurement (ICHOM) define ‘outcomes’ as: “The results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives” (1). ICHOM was established in 2014 as a partnership between Harvard Business School, Boston Consulting Group, and the Karolinska Institutet in Sweden to set a global standard for outcomes measurement at the level of the clinical condition.