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Practitioners Working Group Meeting with Paul Krabbe on PROMs

In this session, practitioners explored how to critically select and use PROMs for meaningful quality improvement

Understanding PROMs: From Traditional Measures to Patient-Centered Instruments


Summary:The VBHC Suisse Practitioners' Working Group gathered to deepen their understanding of patient-reported outcome measures (PROMs), exploring the limitations of traditional instruments, the role of patient preference in outcome measurement, and the importance of context-driven tool selection. The session featured insights from an expert in quantitative psychology and health measurement, emphasizing a shift towards more patient-centered and meaningful data collection in primary care.

Table of Contents

  1. Introduction: Why Not All PROMs Are the Same

  2. Traditional Questionnaires: SF-12, SF-36, and Their Pitfalls

  3. The Role of Purpose in Tool Selection

  4. Preference-Based Instruments vs. Classical Tools

  5. Measurement Theory Basics: From Likert to Item Response Theory

  6. Health Utilities and Composite Indices

  7. Real-World Applications: Chronic Pain, Transplant Patients

  8. Patient Involvement in Instrument Development

  9. The Challenge of Policy-Level Decision-Making

  10. The Future of PROMs in Value-Based Healthcare


Key Takeaways

1. Not All PROMs Are Fit for All PurposesThe session challenged the assumption that one generic questionnaire can serve all contexts. For instance, the SF-12 is widely used but lacks the depth to assess certain patient needs—especially when it comes to the severity and impact of symptoms.

2. Classical vs. Preference-Based ToolsTraditional questionnaires often assume equal weight across domains (e.g., mobility, pain, social functioning), while preference-based tools assign different values based on patient experience. These weights matter when combining outcomes across domains for decision-making.

3. The Case for Patient-Centered DesignMost widely used PROMs were developed by experts, not patients. The speaker emphasized the value of co-developing instruments with patients, sharing examples where key symptoms like fatigue were missed entirely in expert-developed tools.

4. Simplicity with Scientific RigorThe goal is to design PROMs that are both intuitive for patients and scientifically robust. The session introduced new tools and apps that allow patients to rate and prioritize their symptoms in a user-friendly way, while also generating data that can be used for complex statistical analysis.

5. Beyond Clinical Use: Relevance for PolicyPROMs data is increasingly used to inform reimbursement and public health decisions. However, not all instruments are suitable for these high-level purposes. Tools that generate utility values (e.g., EQ-5D) are preferred by health economists and policymakers.

6. The Dutch Experience: Cost-Effectiveness vs. RealityUsing the Netherlands as an example, the discussion highlighted how decisions about reimbursement often involve political and social considerations—not just cold cost-effectiveness analyses.




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