Patient-Reported Outcomes Assessment in the Practice Setting

Maureen Hannley, PhD, is currently Chief of the Research Division of the Department of Otolaryngology and Communication Sciences at Medical College of Wisconsin and Research Consultant for the Triological Society. She formerly served as the Chief Research Officer of the American Academy of Otolaryngology- Head and Neck Surgery Foundation and has held positions at the National Institutes of Health, Stanford University Medical School, and Arizona State University.

How are your patients doing? Do you know the impact of their disorders-and the management approach you selected for them-on their health-related quality of life? An audiogram may tell you a patient’s type, degree, and configuration of hearing impairment, but it doesn’t tell you the impact of that impairment on her emotional status because she can no longer play cards with her friends, participate in conversations in a noisy restaurant, or hear the secrets whispered to her by her granddaughter. Polysomnography will yield an apnea-hypopnea index, but does not reflect the ways in which sleep-disordered breathing can affect how much energy a person has, how he manages in the workplace, or how he functions behind the wheel of a vehicle. Such information must come directly from the patient and it is highly individual.

Outcomes research is concerned with effectiveness, or the impact of the intervention on the overall health and well-being of the typical patient under real-world circumstances.

Every clinician is interested in the outcome of his or her treatment, and many providers and consumers of health care believe that patient outcomes should be evaluated as a part of routine patient care. Patient outcomes, however, has evolved into something of an umbrella term used loosely to encompass medical outcomes, health-related quality of life, patient/customer service satisfaction with care, and cost/operations of care. Increasingly, information about symptoms and performance is being gathered directly from patients using structured questionnaires that have been shown to yield meaningful, quantitative assessments of how patients feel and how they function with their disorders and as a result of treatment-measures that are called patient-reported outcomes (PROs).1 In this article we will focus on disease-specific outcomes measures in otolaryngology-head and neck surgery that can be completed by your patients before and after treatment, enabling you to track these very important outcomes with a minimum of disruption to your normal practice routine. This column will focus on selecting the right outcome instrument for your purpose; the next one will describe how to implement an outcomes assessment program in your practice.