title: The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature.
abstract: OBJECTIVE
  The purpose of this paper is to summarize the best evidence regarding the impact of providing patient-reported outcomes (PRO) information to health care professionals in daily clinical practice.
  
  
  METHODS
  Systematic review of randomized clinical trials (Medline, Cochrane Library; reference lists of previous systematic reviews; and requests to authors and experts in the field).
  
  
  RESULTS
  Out of 1,861 identified references published between 1978 and 2007, 34 articles corresponding to 28 original studies proved eligible. Most trials (19) were conducted in primary care settings performed in the USA (21) and assessed adult patients (25). Information provided to professionals included generic health status (10), mental health (14), and other (6). Most studies suffered from methodologic limitations, including analysis that did not correspond with the unit of allocation. In most trials, the impact of PRO was limited. Fifteen of 23 studies (65%) measuring process of care observed at least one significant result favoring the intervention, as did eight of 17 (47%) that measured outcomes of care.
  
  
  CONCLUSIONS
  Methodological concerns limit the strength of inference regarding the impact of providing PRO information to clinicians. Results suggest great heterogeneity of impact; contexts and interventions that will yield important benefits remain to be clearly defined.
authors.affiliation: National Primary Care Research and Development Center, The University of Manchester, Manchester, UK. jose.valderas@manchester.ac.uk
authors.forename: J M
authors.initials: JM
authors.lastname: Valderas
authors.forename: A
authors.initials: A
authors.lastname: Kotzeva
authors.forename: M
authors.initials: M
authors.lastname: Espallargues
authors.forename: G
authors.initials: G
authors.lastname: Guyatt
authors.forename: C E
authors.initials: CE
authors.lastname: Ferrans
authors.forename: M Y
authors.initials: MY
authors.lastname: Halyard
authors.forename: D A
authors.initials: DA
authors.lastname: Revicki
authors.forename: T
authors.initials: T
authors.lastname: Symonds
authors.forename: A
authors.initials: A
authors.lastname: Parada
authors.forename: J
authors.initials: J
authors.lastname: Alonso
mesh_terms: D005246:Feedback; D006305:Health Status Indicators; D006801:Humans; D017060:Patient Satisfaction; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic