Methods for Developing Patient-Reported Outcome-Based Performance Measures (PRO-PMs)

Value Health. 2015 Jun;18(4):493-504. doi: 10.1016/j.jval.2015.02.018. Epub 2015 May 21.


Objective: To recommend methods for assessing quality of care via patient-reported outcome-based performance measures (PRO-PMs) of symptoms, functional status, and quality of life.

Methods: A Technical Expert Panel was assembled by the American Medical Association-convened Physician Consortium for Performance Improvement. An environmental scan and structured literature review were conducted to identify quality programs that integrate PRO-PMs. Key methodological considerations in the design, implementation, and analysis of these PRO-PM data were systematically identified. Recommended methods for addressing each identified consideration were developed on the basis of published patient-reported outcome (PRO) standards and refined through public comment. Literature review focused on programs using PROs to assess performance and on PRO guidance documents.

Results: Thirteen PRO programs and 10 guidance documents were identified. Nine best practices were developed, including the following: provide a rationale for measuring the outcome and for using a PRO-PM; describe the context of use; select a measure that is meaningful to patients with adequate psychometric properties; provide evidence of the measure's sensitivity to differences in care; address missing data and risk adjustment; and provide a framework for implementation, interpretation, dissemination, and continuous refinement.

Conclusion: Methods for integrating PROs into performance measurement are available.

Keywords: PRO-PM; patient-reported outcome; performance measurement; quality.

MeSH terms

  • American Medical Association*
  • Clinical Competence / standards*
  • Humans
  • Patient Outcome Assessment*
  • Psychometrics
  • Self Report / standards*
  • United States