title: Using Patient-Reported Information to Improve Clinical Practice.
abstract: OBJECTIVE
  To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives.
  
  
  METHODS
  Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries.
  
  
  METHODS
  We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians.
  
  
  RESULTS
  First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the public and private sectors in financing PRI and orchestrating an appropriate balance among its four forms.
  
  
  CONCLUSIONS
  Unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value. Certain policy parameters are already clear, but additional research is required to clarify how best to collect patient narratives in varied settings, how to report narratives to consumers in conjunction with quantified metrics, and how to promote a "culture of learning" at the practice level that incorporates patient feedback.
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, Room 304 LEPH 60 College St, New Haven, CT 06520.
authors.forename: Mark
authors.initials: M
authors.lastname: Schlesinger
authors.affiliation: Center for Patient Partnerships, UW Law School, University of Wisconsin-Madison, Madison, WI.|Department of Family Medicine, UW Medical School, University of Wisconsin-Madison, Madison, WI.
authors.forename: Rachel
authors.initials: R
authors.lastname: Grob
authors.affiliation: Shaller Consulting Group, Stillwater, MN.
authors.forename: Dale
authors.initials: D
authors.lastname: Shaller
mesh_terms: D006302:Health Services Research; D006801:Humans; D063868:Patient Outcome Assessment; D010816:Physician Incentive Plans; D058996:Quality Improvement; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D011795:Surveys and Questionnaires
keywords: Patient experience; patient narratives; patient-reported outcomes; pay-for-performance; public reporting