Can Patient-Reported Outcomes Combat Physician Burnout?

Bridget M. Kuehn

October 05, 2017

Implementing routine use of patient-reported outcomes (PROs) at Partners HealthCare in Boston, Massachusetts, has boosted physician and patient satisfaction, according to a perspective article published today in the New England Journal of Medicine (NEJM).

In 2012, the Boston-based health system introduced PROs into routine practices throughout the multihospital system, note Lisa Rotenstein, MD, MBA, a clinical fellow at Harvard Medical School, and colleagues. Patients now routinely answer questionnaires about their outcomes, symptoms, and quality of life on iPads in their physician's waiting room or on electronic devices at home.

To gauge the success of the initiative, the organization collects feedback from 1500 physicians through regular visits by program staff and specialty meetings. It then used the feedback to conduct 25 qualitative interviews with physicians and other clinicians about how PROs affected their patients and their practice. Dr Rotenstein and colleagues describe the results of these efforts in their NEJM report.

At first, clinicians were concerned about the time required for PROs and the effect they would have on workflows, according to the authors. In addition, early on in the effort much of the feedback focused on technical difficulties with wireless network reliability and ease of use for patients and providers.

Over time, however, the feedback has indicated that clinicians find PROs valuable.

"Evidence from experienced users suggests PRO collection is not only feasible and good for clinical care but also may enhance physician satisfaction and prevent burnout," Dr Rotenstein and colleagues write.

For example, providers reported having better information about patient symptoms and outcomes. "The knowledge gained from these assessments often differed from physicians' long-held assumptions and helped them better ally with patients during the recovery process," they continue.

It also often helped improve patient care. For example, a routine questionnaire revealed that a patient with poorly controlled diabetes and cancer who made frequent emergency department visits had depression. The discovery enabled the patient to receive appropriate mental health care and greatly improved her diabetes control.

Clinicians also reported improved workflows and time efficiencies with routine PRO use. One physician, for example, reported that the questionnaires saved her 10 minutes each annual exam and allowed her to "be a doctor again" instead of having to spend visits on checklists.

Patients also seemed more willing to divulge sensitive information in the electronic surveys, enabling clinicians to discuss issues during the visit like sexual function, incontinence, rectal bleeding, or even domestic abuse.

Overall, the results suggest that both clinicians and patients agree the process is gathering useful and actionable information, said Danielle Lavallee, PharmD, PhD, a research associate professor in the Division of General Surgery at the University of Washington in Seattle, who was not involved in the study.

"It is those 'ah ha' moments that really spoke to me in the article," she said.

The findings are consistent with an emerging body of evidence suggesting that PROs may improve the quality of care, Dr Lavallee told Medscape Medical News. However, she noted that much of the research to date on PROs has been done in oncology, and more work is needed to verify the benefits in other specialties.

"The experience in oncology may not translate to other fields," she explained.

Still, Dr Lavallee expects that further streamlining of the processes for gathering PROs, especially outside of visit hours, will continue to improve the experience of both patients and physicians.

"As health information technology continues to evolve, it will make it more efficient," she said. "It is helpful for the patient to think about the visit before they come in and it helps prepare the healthcare team prior to the visit."

As these efforts progress, Dr Lavallee also emphasized the importance of identifying patients who may not be reached by these electronic data collection efforts because of cultural, language, or personal preferences and making sure their needs are also met.

The authors acknowledged that implementing PROs requires substantial investments in electronic devices and electronic data collection systems.

"Despite these challenges, we believe PROs have the potential to reengage patients and physicians in the care delivery process," they conclude.

The authors have disclosed no relevant financial relationships other than employment at Partners HealthCare.

N Engl J Med. 2017;377:1309-1312. Abstract

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