title: Patient-reported outcomes: pathways to better health, better services, and better societies.
abstract: While the use of PROs in research is well established, many challenges lie ahead as their use is extended to other applications. There is consensus that health outcome evaluations that include PROs along with clinician-reported outcomes and administrative data are necessary to inform clinical and policy decisions. The initiatives presented in this paper underline evolving recognition that PROs play a unique role in adding the patient perspective alongside clinical (e.g., blood pressure) and organizational (e.g., admission rates) indicators for evaluating the effects of new products, selecting treatments, evaluating quality of care, and monitoring the health of the population. In this paper, we first explore the use of PRO measures to support drug approval and labeling claims. We critically evaluate the evidence and challenges associated with using PRO measures to improve healthcare delivery at individual and population levels. We further discuss the challenges associated with selecting from the abundance of measures available, opportunities afforded by agreeing on common metrics for constructs of interest, and the importance of establishing an evidence base that supports integrating PRO measures across the healthcare system to improve outcomes. We conclude that the integration of PROs as a key end point within individual patient care, healthcare organization and program performance evaluations, and population surveillance will be essential for evaluating whether increased healthcare expenditure is translating into better health outcomes.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK.
authors.forename: N
authors.initials: N
authors.lastname: Black
authors.affiliation: LORA Group, LLC, Royal Oak, MD, USA.
authors.forename: L
authors.initials: L
authors.lastname: Burke
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Forrest
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: U H Ravens
authors.initials: UH
authors.lastname: Sieberer
authors.affiliation: Faculty of Medicine, McGill University, Montreal, QC, Canada.|School of Physical and Occupational Therapy, University Health Center's Division of Clinical Epidemiology, Clinical and Health Informatics, Montreal, QC, Canada.|Centre de recherche interdisciplinaire en réadaptation, Montreal, QC, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx) (Person Centred Care), University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Valderas
authors.affiliation: Faculty of Medicine, McGill University, Montreal, QC, Canada. susan.bartlett@mcgill.ca.
authors.forename: S J
authors.identifier: http://orcid.org/0000-0001-9755-2490
authors.initials: SJ
authors.lastname: Bartlett
authors.affiliation: Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Alonso
mesh_terms: D003695:Delivery of Health Care; D006304:Health Status; D006801:Humans; D063868:Patient Outcome Assessment; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D011788:Quality of Life
keywords: Health evaluations; Health services; Patient-reported outcomes; Population monitoring