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Care quality measurement plays an essential role in the healthcare field and requires properly quantified outcomes’ thorough application. Patient-reported outcomes (PROs) and hospital outcomes (HOs) or the outcomes that hospitals report exemplify two dissimilar approaches to measuring changes to the health status resulting from medical and care services. PROs and HOs differ in many ways, including data source, objectivity, verifiability, measurement approaches, and correlations with other outcomes.
As the terms suggest, the key difference between PROs and HOs is the source of data. PROs refer to any reports of the patient’s health status that “come directly from the patient…without interpretation by a clinician or anyone else” (Johnston et al., 2019, p. 479). One example of PROs is the health-related quality of life (HRQoL) measured by self-report questionnaires. Also referred to as “functional status” and “well-being,” the HRQoL is a multi-area outcome assessed using various outcome measures, including condition-specific questionnaires and handicap inventories (Johnston et al., 2019, p. 486). HOs are reported by hospitals by processing patient outcome data from medical records. One example of HOs is the readmission rate or the proportion of admitted healthcare clients returning to the hospital within a specific timeframe (Lingsma et al., 2018). To be based on established facts and give rise to accurate hospital quality estimates, objective patient outcome statistics are checked carefully.
PROs and HOs also greatly vary in terms of the degree of objectivity and the extent to which they are aligned with verifiable facts. For instance, PROs are utilized when collecting externally observable condition-specific data would be challenging, which could take place in the case of disorders affecting emotional regulation and involving painful conditions of different etiology (Johnston et al., 2019). Studies focusing on analyzing PROs’ correlations with objective health-related findings are indicative of their imperfect reliability as a decision-making tool. In particular, patients’ self-reported QoL and pain outcomes have been shown to “correlate poorly…with clinician-reported outcomes, biomarkers, and performance” in several respiratory and musculoskeletal disorders (Johnston et al., 2019, p. 480). In contrast, care outcomes reported by hospitals refer to achievements that are subject to external observation and find direct support in care facilities’ statistics.
Other differences pertain to the approaches to quality measurement relevant to PROs and HOs and correlations with other indicators. With PROs, patient-reported data are often collected via generic instruments or patient questionnaires that produce separate results for multiple dimensions of well-being. In tools for measuring the HRQoL, such dimensions might include social function, physical well-being, emotional well-being, self-care, and many other variables pertinent to specific diseases, pain type, or age groups (Johnston et al., 2019). For hospital-reported information, common HOs utilize the standardized outcome approach in which observed values are divided by the expected ones (Lingsma et al., 2018). In the case of HOs, standardization serves to ensure the opportunity to analyze individual hospitals’ quality comparatively. PROs, such as the HRQoL estimates, are not always perfectly correlated with patients’ objective medical findings, whereas specific HOs can be interconnected (Johnston et al., 2019; Lingsma et al., 2018). For instance, hospitals’ low readmission rates can sometimes stem from high mortality rates (Lingsma et al., 2018). Thus, the outcomes’ objective or subjective nature explains inter-outcome connections and opportunities for comparisons.
To sum up, PROs and HOs are notably different in terms of undergoing the process of professional review or external interpretation. Having dissimilar sources, these two outcome types vary in terms of objectivity, being related to clear facts, and applicability to the comparisons of care quality between different facilities. Potentially, both types can lead to improvements in care quality and patient satisfaction if analyzed carefully.
References
Johnston, B. C., Patrick, D. L., Devji, T., Maxwell, L. J., Bingham III, C. O., Beaton, D. E., Boers, M., Briel, M., Busse, J. W., Carrasco-Labra, A., Christensen, R., Da Costa, B., El Dib, R., Lyddiatt, A., Ostelo, R. W., Shea, B., Singh, J., Terwee, C. B., Williamson, P. R.,… Guyatt, G. H. (2019). Patient-reported outcomes. In J. P. Higgins et al. (Eds.), Cochrane handbook for systematic reviews of interventions (6th ed., pp. 479-492). John Wiley & Sons.
Lingsma, H. F., Bottle, A., Middleton, S., Kievit, J., Steyerberg, E. W., & Marang-Van De Mheen, P. J. (2018). Evaluation of hospital outcomes: The relation between length-of-stay, readmission, and mortality in a large international administrative database.BMC Health Services Research, 18(1), 1-10. Web.
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