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Becoming PROs at listening to patients.

Posted By Sheri Winsper, RN, MSN, MSHA , Thursday, August 27, 2020

Fully understanding the quality of care we deliver and how we might improve it is critical to providing the person-centered care that leads to better health outcomes. For too long we left the patient’s  perspective out of our measurements of quality, looking at clinical outcomes through a narrow lens that failed to capture a wider range of patient conditions and experiences. Fortunately, the healthcare community came together, and National Quality Forum (NQF) helped to develop guidance to ensure Patient Reported Outcomes (PROs) offer unfiltered patient perspectives to drive quality improvements. This collaborative effort, started in 2012 and refined ever since, has the promise to dramatically improve the quality and value of healthcare when adopted system-wide.

PROs surface the patients’ voice and empower them in their treatment, filling a communication gap that may exist between doctors and patients. The Food and Drug Administration (FDA) defines PROs as a “report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” PROs are collected via PRO Measures (PROMs), questionnaires that paint an accurate picture of the patients’ mental, physical, and/or social health. For instance, the metric PHQ-9 is a PROM that focuses on recognizing and identifying a patient who may have depression. A higher PHQ-9 score could help clinicians determine if the patient would benefit from anti-depressants or other therapies/treatments. The PHQ-9 creates an opportunity to capture important information that may have been missed without direct input from the patient. 

NQF has a longstanding history of bringing diverse healthcare experts and patient advocates together for consensus-based review of measures for PROs. In 2012, the Department of Health and Human Services funded NQF to facilitate collaboration on developing, testing, endorsing, and implementing PRO performance measures (PRO-PMs), which are based on aggregated data from PROs. That resulted in our report, Patient-Reported Outcomes in Performance Measurement, which spurred the use of PRO-PMs to improve quality in patient care. Today, NQF endorses PRO-PMs developed by healthcare stewards and stakeholders for accountability and performance improvement.

As part of our commitment to continuous quality improvement, last year NQF convened a multi-stakeholder Technical Expert Panel to identify best practices in selecting PROs and collecting and applying data. In 2019, NQF published the Patient-Reported Outcomes Environmental Scan summarizing the panel’s deliberations and findings. NQF continues to do more research and work in the field of PROs, PROMs, and PRO-PMs to determine the clearest, most accurate way to hear and act upon the patient’s perspective regarding what health outcomes are important to them. A final report will be released in early September.

Fully understanding patients’ health, outcomes, quality of life, and experiences are critical to activating them as equal partners in healthcare decisions and driving measurable health improvements together. Care must be informed by those we care for; and many healthcare stakeholders agree on the importance of PROs. Without patient reported outcomes, we miss the opportunity to provide the best possible person-centered care.


Sheri Winsper, RN, MSN, MSHA leads the careful evaluation and endorsement of consensus standards, the Measures Application Partnership (MAP), and Measurement Frameworks central to NQF's ongoing mission to drive measurable health improvements so that every person experiences high value care. With more than 20 years of health care experience, Sheri has successfully provided service oriented strategic, operational, and clinical quality and patient safety leadership through the design and implementation of innovative methodologies in quality measurement, improvement, and culture of high reliability safety initiatives at the national, integrated health system and individual hospital levels.

Winsper is a registered nurse with a Master of Science in Nursing Administration and a Master of Science in Health Care Administration from the University of Texas at Arlington in Arlington, Texas. She received her Bachelor of Science in Nursing from Oklahoma Baptist University in Shawnee, Oklahoma.

About National Quality Forum

The National Quality Forum (NQF) works with members of the healthcare community to drive measurable health improvements together. NQF is a not-for-profit, membership-based organization that gives all healthcare stakeholders a voice in advancing quality measures and improvement strategies that lead to better outcomes and greater value.


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