The only way to find out if your healthcare strategies are working is through reliable measurement.

You cannot control what you do not measure. You only know what you measure, so you must measure what matters.

What matters to patients is how they feel and how much they can do. How they feel includes physical symptoms, such as pain, as well as their mental state, such as feeling low or worried. How much they can do about this is limited by their dependence on others. They can rate this as none, slight, quite a lot and extreme.

Patient-reported outcome measures (PROMs) record patient ratings and monitor changes as a result of healthcare activity. Politicians from all parties have recognised that traditional reimbursement models generate perverse incentives, which maximise activity irrespective of results. They now advocate PROMs as a foundation for commissioning and transforming healthcare services.

Flying blind

PROMs close the virtuous circle, in which quality of care is judged by patient outcomes, which are used to reward excellence, encouraging what works best and so delivering safer, more efficient and effective care. Without such measures we have been flying blind. Outcomes transparency is the missing link to align incentives for payers, providers and clinicians with what matters most for patients. In their modern classic, Redefining Healthcare, Michael Porter and Elizabeth Teisberg state: "Mandatory measurement and reporting of results is perhaps the single most important step in reforming the healthcare system."

However, we need to recognise that patients and clinicians will not willingly collect new data unless it is quick and easy, reliable without training, and contributes directly to better patient care. "Quick and easy" means it should take a patient no more than a few seconds as part of a routine task such as checking in to a clinic using an automated touch-screen patient arrivals kiosk.

PROM ratings should be part of the medical record, shared between patients and clinicians, in order to improve communication and mutual understanding and enhance the doctor-patient relationship, handover and continuity of care, as well as assist in shared decision making.

Generic PROMs allow comparisons across patients, conditions, care settings, treatments and localities, and may be supplemented by or include condition-specific measures. All such measures need to be easy to interpret, clinically relevant, sensitive, responsive to change and adjusted for risk, so we compare apples with apples, not oranges.

A legacy of paperwork

Most existing instruments were originally developed for clinical research using pen and paper, not for large-scale routine data collection.Today, we need PROMs to be part of the social environment of patients and the working environment of clinicians, integrated with electronic clinical information systems. Such systems are already required to keep track of each patient over the whole care journey across primary, secondary, community and social care.

The case for routine health outcome measurement is strong, but the tools need to be fit for purpose, providing managers with the data they need, while being computer-based and acceptable to patients and clinicians. A new generation of such tools is now emerging.

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