Abstract
The increasing use of patient-reported outcome (PRO) measures is forcing clinicians
and health care systems to decide which to select and how to incorporate them into
their records and clinical workflows. This overview addresses 3 topics related to
these concerns. First, a literature review summarizes key psychometric and practical
factors (such as reliability, responsiveness, computer adaptive testing, and interpretability)
in choosing PROs for clinical practice. Second, 3 clinical decision support issues
are highlighted: gathering PROs, electronic health record effect on providers, and
incorporating PROs into clinical decision support design and implementation. Lastly,
the salience of crosscutting domains as well as 9 key pragmatic decisions are reviewed.
Crosscutting domains are those that are relevant across most medical and mental health
conditions, such as the SPADE symptom pentad (sleep problems, pain, anxiety, depression,
low energy/fatigue) and physical functioning. The 9 pragmatic decisions include (1)
generic vs disease-specific scales; (2) single- vs multidomain scales; (3) universal
scales vs user-choice selection; (4) number of domains to measure; (5) prioritization
of domains when multiple domains are assessed; (6) action thresholds; (7) clinical
purpose (screening vs monitoring); as well as the (8) frequency and (9) logistical
aspects of PRO administration.
Keywords
List of abbreviations:
CAT (computer adaptive testing), EHR (electronic health record), IRT (item response theory), MCAT (multidimensional computer adaptive testing), MID (minimally important difference), PHQ (Patient Health Questionnaire), PRO (patient-reported outcome), PROMIS (Patient-Reported Outcome Measurement Information System), SPADE (sleep problems, pain, anxiety, depression, and low energy/fatigue), UCAT (unidimensional computer adaptive testing)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 09, 2021
Accepted:
December 8,
2020
Received:
November 12,
2020
Footnotes
Disclosures: none.
This paper is part of a supplement from the American Congress of Rehabilitation Medicine.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
