J Manag Care Spec Pharm. 2018 Mar;24(3):304-310. doi: 10.18553/jmcp.2018.17491. Epub 2018 Feb 20.
Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions. While there have been significant strides by key health care stakeholders to further the development and use of PROs, there are a number of challenges limiting more widespread use. In light of these current challenges and the potential for PROs to improve health care quality and value, on October 19, 2017, the Academy of Managed Care Pharmacy convened a forum of key stakeholders representing patients, payers, providers, government, and pharmaceutical companies to discuss and identify solutions to the current challenges and barriers to further use of PROs. These discussions informed the development of participants' ideal future state in which PROs maximize the goals of all health care stakeholders and the actionable steps required to make the future state a reality. While stakeholders shared unique perspectives throughout the forum, they had consensus on 2 overarching issues: the importance of PROs in defining value, improving patient care, and implementing value-based payment models and the need for strong organizational and operational systems to achieve optimal adoption and use. Participants identified several key challenges in PRO use and adoption: achieving a representative patient population, inclusion of PRO data in medication labels, the necessity for both standardized and customizable PROs, and operational and organizational barriers to collecting and analyzing PROs. To overcome these challenges, participants recommended that manufacturers should engage key stakeholders early and throughout the drug development process to ensure the most valid and representative PROs and patient populations will be included. To streamline the PRO collection process, participants suggested engaging pharmacists and other providers who may have more frequent interaction with patients. Participants also recommended that PRO collection and analysis should use common technology platforms, streamline components of clinician care to reduce workflow, and be integrated with claims data to provider payers a better understanding of patient health in real time. Finally, additional work should be done to develop patient-reported outcome measures that contain relevant measures for all healthcare stakeholders. While significant challenges remain in PRO development and adoption, participants agreed that greater use can only be achieved through collaboration and patient-centered care.
The AMCP Partnership Forum titled "Improving Quality, Value, and Outcomes with Patient-Reported Outcomes" and the development of this proceedings report were supported by Amgen, Boehringer Ingelheim Pharmaceuticals, Genentech, GlaxoSmithKline, Novartis Pharmaceuticals, Novo Nordisk, Precision for Value, Premier, Sanofi, Takeda Pharmaceuticals USA, and Xcenda.
患者报告的结果(PROs)直接衡量患者的健康状况或治疗偏好,是向以患者为中心的医疗保健转变的关键组成部分。PROs 可以在整个护理连续体中衡量患者特定疾病和整体健康状况,使它们能够为主要医疗保健利益相关者的各种用途提供服务。目前,PROs 用于药物开发,在护理中使患者和临床医生的目标保持一致,用于护理质量措施以及覆盖范围和报销决策。尽管主要医疗保健利益相关者在进一步开发和使用 PROs 方面取得了重大进展,但仍存在许多限制其更广泛使用的挑战。鉴于当前的挑战和 PROs 改善医疗保健质量和价值的潜力,2017 年 10 月 19 日,管理式医疗药剂师协会召集了一个由代表患者、支付方、提供者、政府和制药公司的主要利益相关者参加的论坛,以讨论和确定进一步使用 PROs 的当前挑战和障碍的解决方案。这些讨论为参与者制定了理想的未来状态,即 PROs 最大化所有医疗保健利益相关者的目标,并制定了实现未来状态所需的可操作步骤。虽然利益相关者在整个论坛上分享了独特的观点,但他们在两个总体问题上达成了共识:PROs 在定义价值、改善患者护理和实施基于价值的支付模式方面的重要性,以及实现最佳采用和使用所需的强大组织和运营系统。参与者确定了 PRO 使用和采用方面的几个关键挑战:实现有代表性的患者群体,将 PRO 数据纳入药物标签,标准化和定制 PRO 的必要性,以及收集和分析 PRO 的运营和组织障碍。为了克服这些挑战,参与者建议制造商应在药物开发过程中尽早并与主要利益相关者接触,以确保纳入最有效和最具代表性的 PROs 和患者群体。为了简化 PRO 收集过程,参与者建议让药剂师和其他可能与患者有更频繁互动的提供者参与进来。参与者还建议,PRO 的收集和分析应使用通用的技术平台,简化临床医生护理的组件以减少工作流程,并与理赔数据集成,以便支付方实时更好地了解患者的健康状况。最后,应开展更多工作来开发包含所有医疗保健利益相关者相关措施的患者报告结果衡量指标。尽管 PRO 的开发和采用仍然存在重大挑战,但参与者一致认为,只有通过协作和以患者为中心的护理,才能实现更广泛的使用。
名为“通过患者报告的结果改善质量、价值和结果”的 AMCP 合作伙伴论坛以及本报告的编写得到了安进、勃林格殷格翰制药公司、基因泰克、葛兰素史克、诺华制药公司、诺和诺德、精准价值、顶峰、赛诺菲、武田制药美国公司和 Xcenda 的支持。