Quality of Life Research

, Volume 17, Issue 10, pp 1297–1302 | Cite as

Prospects and challenges in using patient-reported outcomes in clinical practice

  • Constance H. FungEmail author
  • Ron D. Hays



Patient-reported measures include preferences and reports about care received, health behaviors, and outcomes of care (patient satisfaction and health-related quality of life). These measures are a core aspect of health care, but there is much to be learned about how to use them to improve clinical practice.


We specify linkages among different patient-reported measures and focus upon the prospects and challenges for use of patient-reported outcomes in clinical practice.


Patient-reported measures are important throughout the continuum of patient care. At the initial visit, patient-reported outcomes provide information about what is important to the patient, the patient’s current behaviors, and the patient’s baseline health-related quality of life. At subsequent visits, patient-reported outcomes help evaluate disease progression or regression as well as treatment effects.


Patient-reported measures can help clinicians target interventions that will improve patient outcomes of care. However, there are a number of challenges in using patient-reported outcomes in clinical practice.


Quality of life Quality indicators, health care Outcome assessment, health care 



We thank Theodore G. Ganiats, MD for his insightful comments on an earlier version of this manuscript. Dr. Fung was supported by funding from the Society of General Internal Medicine (through a grant from the American Board of Internal Medicine Foundation and the Commonwealth Fund). Dr. Fung is an employee of Zynx Health, Incorporated. Dr. Hays was supported by the a P01 grant (AG020679-01) from the National Institute on Aging and the UCLA Center for Health Improvement in Minority Elderly/Resource Centers for Minority Aging Research, NIH/NIA/NCMHD (P30-AG-021684-07). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of Zynx Health, which develops evidence-based tools for healthcare providers, or David Geffen School of Medicine at UCLA.


  1. 1.
    The Healthcare Effectiveness Data and Information Set (HEDIS). (2008). National Committee for Quality Assurance. Available from: Accessed 17 March 2008.
  2. 2.
    Department of Veterans Affairs. (2001). External Peer Review Program. VHA Directive 2001-015. Available from: Accessed 17 March 2008.
  3. 3.
    Higginson, I. J., & Carr, A. J. (2001). Measuring quality of life: Using quality of life measures in the clinical setting. BMJ (Clinical Research Ed.), 322(7297), 1297–1300. doi: 10.1136/bmj.322.7297.1297.CrossRefGoogle Scholar
  4. 4.
    Food and Drug Administration. (2006). Guidance for industry. Patient-reported outcome measures: Use in medical product development to support labeling claims. Available from: Accessed 17 March 2008.
  5. 5.
    Makoul, G. (2001). Essential elements of communication in medical encounters: The Kalamazoo consensus statement. Academic Medicine, 76(4), 390–393. doi: 10.1097/00001888-200104000-00021.PubMedCrossRefGoogle Scholar
  6. 6.
    Mauksch, L. B., Dugdale, D. C., Dodson, S., & Epstein, R. (2008). Relationship, communication, and efficiency in the medical encounter: Creating a clinical model from a literature review. Archives of Internal Medicine, 168(13), 1387–1395. doi: 10.1001/archinte.168.13.1387.PubMedCrossRefGoogle Scholar
  7. 7.
    Noel, P. H., Chris Frueh, B., Larme, A. C., Pugh, J. A., Noel, P. H., Williams, J. W., Jr., et al. (2005). Collaborative care needs and preferences of primary care patients with multimorbidity. Health Expectations, 8(1), 54–63. doi: 10.1111/j.1369-7625.2004.00312.x.PubMedCrossRefGoogle Scholar
  8. 8.
    Calkins, D. R., Rubenstein, L. V., Cleary, P. D., Davies, A. R., Jette, A. M., Fink, A., et al. (1991). Failure of physicians to recognize functional disability in ambulatory patients. Annals of Internal Medicine, 114(6), 451–454.PubMedGoogle Scholar
  9. 9.
    McHorney, C. A. (1999). Health status assessment methods for adults: Past accomplishments and future challenges. Annual Review of Public Health, 20, 309–335. doi: 10.1146/annurev.publhealth.20.1.309.PubMedCrossRefGoogle Scholar
  10. 10.
    Velikova, G., Booth, L., Smith, A. B., Brown, P. M., Lynch, P., Brown, J. M., et al. (2004). Measuring quality of life in routine oncology practice improves communication and patient well-being: A randomized controlled trial. Journal of Clinical Oncology, 22(4), 714–724. doi: 10.1200/JCO.2004.06.078.PubMedCrossRefGoogle Scholar
  11. 11.
    Espallargues, M., Valderas, J. M., & Alonso, J. (2000). Provision of feedback on perceived health status to health care professionals: A systematic review of its impact. Medical Care, 38(2), 175–186. doi: 10.1097/00005650-200002000-00007.PubMedCrossRefGoogle Scholar
  12. 12.
    Jaen, C. R., Stange, K. C., & Nutting, P. A. (1994). Competing demands of primary care: A model for the delivery of clinical preventive services. The Journal of Family Practice, 38(2), 166–171.PubMedGoogle Scholar
  13. 13.
    Nutting, P. A., Baier, M., Werner, J. J., Cutter, G., Conry, C., & Stewart, L. (2001). Competing demands in the office visit: What influences mammography recommendations? The Journal of the American Board of Family Practice, 14(5), 352.PubMedGoogle Scholar
  14. 14.
    Detmar, S. B., Muller, M. J., Schornagel, J. H., Wever, L. D., & Aaronson, N. K. (2002). Health-related quality-of-life assessments and patient–physician communication: A randomized controlled trial. Journal of the American Medical Association, 288(23), 3027. doi: 10.1001/jama.288.23.3027.PubMedCrossRefGoogle Scholar
  15. 15.
    Wasson, J., Hays, R., Rubenstein, L., Nelson, E., Leaning, J., Johnson, D., et al. (1992). The short-term effect of patient health status assessment in a health maintenance organization. Quality of Life Research, 1(2), 99–106. doi: 10.1007/BF00439717.PubMedCrossRefGoogle Scholar
  16. 16.
    Wasson, J. H., Stukel, T. A., Weiss, J. E., Hays, R. D., Jette, A. M., & Nelson, E. C. (1999). A randomized trial of the use of patient self-assessment data to improve community practices. Effective Clinical Practice, 2(1), 1–10.PubMedGoogle Scholar
  17. 17.
    Greenhalgh, J., Long, A. F., & Flynn, R. (2005). The use of patient reported outcome measures in routine clinical practice: Lack of impact or lack of theory? Social Science & Medicine, 60(4), 833–843. doi: 10.1016/j.socscimed.2004.06.022.CrossRefGoogle Scholar
  18. 18.
    Kaplan, S. H., Kravitz, R. L., & Greenfield, S. (2000). A critique of current uses of health status for the assessment of treatment effectiveness and quality of care. Medical Care, 38(9, Suppl), II184–II191.PubMedGoogle Scholar
  19. 19.
    Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P. A., et al. (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement. Journal of the American Medical Association, 282(15), 1458–1465. doi: 10.1001/jama.282.15.1458.PubMedCrossRefGoogle Scholar
  20. 20.
    Fihn, S. D., McDonell, M. B., Diehr, P., Anderson, S. M., Bradley, K. A., Au, D. H., et al. (2004). Effects of sustained audit/feedback on self-reported health status of primary care patients. The American Journal of Medicine, 116(4), 241–248. doi: 10.1016/j.amjmed.2003.10.026.PubMedCrossRefGoogle Scholar
  21. 21.
    Calkins, D. R., Rubenstein, L. V., Cleary, P. D., Davies, A. R., Jette, A. M., Fink, A., et al. (1994). Functional disability screening of ambulatory patients: A randomized controlled trial in a hospital-based group practice. Journal of General Internal Medicine, 9(10), 590–592. doi: 10.1007/BF02599291.PubMedCrossRefGoogle Scholar
  22. 22.
    Rubenstein, L. V., McCoy, J. M., Cope, D. W., Barrett, P. A., Hirsch, S. H., Messer, K. S., et al. (1995). Improving patient quality of life with feedback to physicians about functional status. Journal of General Internal Medicine, 10(11), 607. doi: 10.1007/BF02602744.PubMedCrossRefGoogle Scholar
  23. 23.
    Donaldson, G. W., & Moinpour, C. M. (2002). Individual differences in quality-of-life treatment response. Medical Care, 40(6, Suppl), III39–III53. doi: 10.1097/00005650-200206001-00007.PubMedCrossRefGoogle Scholar
  24. 24.
    de Wit, M., Delemarre-van de Waal, H. A., Pouwer, F., Gemke, R. J., & Snoek, F. J. (2007). Monitoring health related quality of life in adolescents with diabetes: A review of measures. Archives of Disease in Childhood, 92(5), 434–439. doi: 10.1136/adc.2006.102236.PubMedCrossRefGoogle Scholar
  25. 25.
    Coons, S. J., Rao, S., Keininger, D. L., & Hays, R. D. (2000). A comparative review of generic quality-of-life instruments. PharmacoEconomics, 17(1), 13–35. doi: 10.2165/00019053-200017010-00002.PubMedCrossRefGoogle Scholar
  26. 26.
    Garratt, A., Schmidt, L., Mackintosh, A., & Fitzpatrick, R. (2002). Quality of life measurement: Bibliographic study of patient assessed health outcome measures. BMJ (Clinical Research Ed.), 324(7351), 1417. doi: 10.1136/bmj.324.7351.1417.CrossRefGoogle Scholar
  27. 27.
    Haywood, K. L., Garratt, A. M., & Fitzpatrick, R. (2005). Quality of life in older people: A structured review of generic self-assessed health instruments. Quality of Life Research, 14(7), 1651–1668. doi: 10.1007/s11136-005-1743-0.PubMedCrossRefGoogle Scholar
  28. 28.
    Hickey, A., Barker, M., McGee, H., & O’Boyle, C. (2005). Measuring health-related quality of life in older patient populations: A review of current approaches. PharmacoEconomics, 23(10), 971–993. doi: 10.2165/00019053-200523100-00002.PubMedCrossRefGoogle Scholar
  29. 29.
    Patel, K. K., Veenstra, D. L., & Patrick, D. L. (2003). A review of selected patient-generated outcome measures and their application in clinical trials. Value in Health, 6(5), 595–603. doi: 10.1046/j.1524-4733.2003.65236.x.PubMedCrossRefGoogle Scholar
  30. 30.
    Phillips, R. L. (2005). Primary care in the United States: Problems and possibilities. BMJ (Clinical Research Ed.), 331(7529), 1400–1402. doi: 10.1136/bmj.331.7529.1400.CrossRefGoogle Scholar
  31. 31.
    Nelson, E. C., Wasson, J. H., Johnson, D. J., & Hays, R. D. (1996). Dartmouth COOP functional health assessment charts: Brief measures for clinical practice. Available from: Accessed 17 March 2008.
  32. 32.
    Nelson, E. C., Landgraf, J. M., Hays, R. D., Wasson, J. H., & Kirk, J. W. (1990). The functional status of patients. How can it be measured in physicians’ offices? Medical Care, 28(12), 1111–1126. doi: 10.1097/00005650-199012000-00001.PubMedCrossRefGoogle Scholar
  33. 33.
    Berwick, D. M., James, B., & Coye, M. J. (2003). Connections between quality measurement and improvement. Medical Care, 41(1, Suppl), I30–I38. doi: 10.1097/00005650-200301001-00004.PubMedGoogle Scholar
  34. 34.
    Hemingway, H., Stafford, M., Stansfeld, S., Shipley, M., & Marmot, M. (1997). Is the SF-36 a valid measure of change in population health? Results from the Whitehall II Study. BMJ (Clinical Research Ed.), 315(7118), 1273–1279.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Zynx Health, IncorporatedLos AngelesUSA
  2. 2.David Geffen School of Medicine at UCLALos Angeles, CAUSA

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