Last week I attended the National Quality Forum (NQF) meeting in Washington, D.C. — Re-engineering Quality Data for Value. Due to the high prevalence rate of multiple co-morbidities among patients, there was much discussion about how to properly risk stratify patients and the increasing need for quality measures directed at care coordination. However, if I could over simply this year’s message in a single phrase, it would be that we need more measures enabling us to “hear the patient’s voice.” There is now a loud cry for the development of patient reported experience of care and patient reported outcome measures, for example.So, it was perfect timing that just as I was getting in the taxi to go to the airport, I received an email that the US Wound Registry’s new quality measure for 2016 was approved– the USWR Patient Reported Wound Outcome Measure.
There has been much talk about the rewriting of the FDA guidance document and the need for surrogate measures of healing. I have been saying that we should develop patient reported outcome measures because that would provide both a surrogate outcome measure for research AND a measure providers can use to satisfy PQRS. When the USWR was unable to get funding from ANYONE for developing a patient reported wound outcome measure, we did it ourselves.
The debacle of the Fedorko trial made it abundantly clear we cannot perform wound healing trials without asking the patient what their outcome was. In that trial, investigators showed a wound photograph to a surgeon who never saw the subject at any time during the entire trial, and then asked the surgeon to predict if the extremity would get amputated. It turns out the surgeons were wrong more often than they were right. Most of the time in this trial, when the surgeon said they would amputate, the patient later healed. The study concluded that HBOT did not work for diabetic foot ulcers when, if we had used patient reported outcomes instead of a misleading one like that, it would have entirely changed the conclusions. All anyone had to do was ask the patient.
One of the speakers during the NQF meeting made the comment, “Patients can tell you if treatment A works better than treatment B.” This could be a big deal for clinical trials. I am tired of hearing everyone talk about what we need and then no one actually doing it. The USWR tool is not perfect, but it is a start. At least, now we have a tool to use to ask patients what they think their outcome was– and providers can get PQRS credit for reporting it.
Very interested in your comments – Let’s keep the conversation going.
Do the Right Thing!™
Caroline Fife, MD
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