title: Methods for Developing Patient-Reported Outcome-Based Performance Measures (PRO-PMs).
abstract: OBJECTIVE
  To recommend methods for assessing quality of care via patient-reported outcome-based performance measures (PRO-PMs) of symptoms, functional status, and quality of life.
  
  
  METHODS
  A Technical Expert Panel was assembled by the American Medical Association-convened Physician Consortium for Performance Improvement. An environmental scan and structured literature review were conducted to identify quality programs that integrate PRO-PMs. Key methodological considerations in the design, implementation, and analysis of these PRO-PM data were systematically identified. Recommended methods for addressing each identified consideration were developed on the basis of published patient-reported outcome (PRO) standards and refined through public comment. Literature review focused on programs using PROs to assess performance and on PRO guidance documents.
  
  
  RESULTS
  Thirteen PRO programs and 10 guidance documents were identified. Nine best practices were developed, including the following: provide a rationale for measuring the outcome and for using a PRO-PM; describe the context of use; select a measure that is meaningful to patients with adequate psychometric properties; provide evidence of the measure's sensitivity to differences in care; address missing data and risk adjustment; and provide a framework for implementation, interpretation, dissemination, and continuous refinement.
  
  
  CONCLUSIONS
  Methods for integrating PROs into performance measurement are available.
authors.affiliation: University of North Carolina, Chapel Hill, NC, USA. Electronic address: ebasch@med.unc.edu.
authors.forename: Ethan
authors.initials: E
authors.lastname: Basch
authors.affiliation: University of Missouri, Kansas City, MO, USA.
authors.forename: John
authors.initials: J
authors.lastname: Spertus
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
authors.affiliation: Johns Hopkins School of Public Health, Baltimore, MD, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Wu
authors.affiliation: Mayo Clinic, Rochester, MN (Patient Representative), USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chuahan
authors.affiliation: Parkinson Pipeline Project, Washington, DC (Patient Representative), USA.
authors.forename: Perry
authors.initials: P
authors.lastname: Cohen
authors.affiliation: Research Advocacy Network, Plano, TX (Patient Representative), USA.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Smith
authors.affiliation: London School of Hygiene and Tropical Medicine, London, England.
authors.forename: Nick
authors.initials: N
authors.lastname: Black
authors.affiliation: American Medical Association, Chicago, IL, USA.
authors.forename: Amaris
authors.initials: A
authors.lastname: Crawford
authors.affiliation: American Medical Association, Chicago, IL, USA.
authors.forename: Keri
authors.initials: K
authors.lastname: Christensen
authors.affiliation: American Medical Association, Chicago, IL, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Blake
authors.affiliation: Palmer College of Chiropractic, Davenport, IA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Goertz
mesh_terms: D000574:American Medical Association; D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D063868:Patient Outcome Assessment; D011594:Psychometrics; D057566:Self Report / Q000592:standards*; D014481:United States
keywords: PRO-PM; patient-reported outcome; performance measurement; quality