Quality of Life Research

, Volume 22, Issue 9, pp 2265–2278 | Cite as

Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review




To assess the impact of providing healthcare professionals with feedback on patient-reported outcome measures (PROMs).


This is a systematic review including controlled studies investigating the effectiveness of PROMs feedback, specifically examining the impact at a group-level and a patient-level.


Only one study provided feedback at a group-level as a measure of professional performance, which found no intervention effect. At a patient-level, sixteen studies were identified and only one study found an overall significant difference in the PROM score. However, an additional six studies found a significant result favouring the intervention group for a particular subgroup or domain. The studies which demonstrated the greatest impact primarily used PROMs as a management tool in an outpatient setting on a specialised patient population. In contrast, there was weak evidence supporting with the use of PROMs as a screening tool. The studies which found a positive effect had a lower quality score on average.


The effectiveness of PROMs feedback seems to be related to the function of the PROM. However, the evidence regarding the impact of PROMs feedback on patient outcomes is weak, and methodological issues with studies are frequent. The use of PROMs as a performance measure is not well investigated. Future research should focus on the appropriate application of PROMs by testing specific hypothesis related to cause and effect. Qualitative research is required to provide a deeper understanding of the practical issues surrounding the implementation of PROMs and the methodological issues associated with the effective use of the information.


Patient-reported outcomes Quality of life Outcome assessment Quality improvement Behavioural change 



Patient-reported outcome measures


National Health Service


Randomised controlled trial


Patient, intervention, comparison, outcome


Standardised mean difference


  1. 1.
    Rosenbloom, S. K., Victorson, D. E., Hahn, E. A., Peterman, A. H., & Cella, D. (2007). Assessment is not enough: a randomized controlled trial of the effects of HRQL assessment on quality of life and satisfaction in oncology clinical practice. Psychooncology, 16(12), 1069–1079. doi:10.1002/pon.1184.PubMedCrossRefGoogle Scholar
  2. 2.
    Greenhalgh, J., & Meadows, K. (1999). The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: A literature review. Journal of Evaluation in Clinical Practice, 5(4), 401–416.PubMedCrossRefGoogle Scholar
  3. 3.
    Deyo, R. A., & Carter, W. B. (1992). Strategies for improving and expanding the application of health status measures in clinical settings. A researcher-developer viewpoint. Medical Care, 30(5 Suppl), MS176–MS186 (discussion MS196-209).Google Scholar
  4. 4.
    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 and Medicine, 60(4), 833–843. doi:10.1016/j.socscimed.2004.06.022.PubMedCrossRefGoogle Scholar
  5. 5.
    Luckett, T., Butow, P. N., & King, M. T. (2009). Improving patient outcomes through the routine use of patient-reported data in cancer clinics: Future directions. Psychooncology, 18(11), 1129–1138. doi:10.1002/pon.1545.PubMedCrossRefGoogle Scholar
  6. 6.
    Sutherland, H. J., & Till, J. E. (1993). Quality of life assessments and levels of decision making: Differentiating objectives. Quality of Life Research, 2(4), 297–303.PubMedCrossRefGoogle Scholar
  7. 7.
    Till, J. E., Osoba, D., Pater, J. L., & Young, J. R. (1994). Research on health-related quality of life: Dissemination into practical applications. Quality of Life Research, 3(4), 279–283.PubMedCrossRefGoogle Scholar
  8. 8.
    Devlin, N., & Appleby, J. (2010). Getting the most out of PROMs: Putting health outcomes at the heart of NHS decision-making. London: King’s Fund.Google Scholar
  9. 9.
    Canadian Institute of Public Health. (2012). Health outcomes of care: An idea whose time has come. Ontario: Ottawa.Google Scholar
  10. 10.
    Health Services Advisory Group. (2011). Medicare Health Outcomes Survey. http://www.hosonline.org/. Accessed 17/11/11.
  11. 11.
    Appleby, J., & Devlin, N. (2004). Measuring success in the NHS. Using patient-assessed health outcomes to manage the performance of healthcare providers. London: King’s Fund.Google Scholar
  12. 12.
    Leonard, K. L., & Masatu, M. C. Using the Hawthorne effect to examine the gap between a doctor’s best possible practice and actual performance. Journal of Development Economics. (in press, corrected proof). doi:10.1016/j.jdeveco.2009.11.001.
  13. 13.
    Moriarty, J. P., & Smallman, C. (2009). En route to a theory of benchmarking. Benchmarking: An International Journal, 16(4), 484–503.CrossRefGoogle Scholar
  14. 14.
    Bridgewater, B., Grayson, A. D., Brooks, N., Grotte, G., Fabri, B. M., Au, J., et al. (2007). Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: An analysis of 25,730 patients undergoing CABG surgery under 30 surgeons over eight years. Heart, 93(6), 744–748. doi:10.1136/hrt.2006.106393.PubMedCrossRefGoogle Scholar
  15. 15.
    Keogh, B., Spiegelhalter, D., Bailey, A., Roxburgh, J., Magee, P., & Hilton, C. (2004). The legacy of Bristol: Public disclosure of individual surgeons’ results. BMJ, 329(7463), 450–454. doi:10.1136/bmj.329.7463.450.PubMedCrossRefGoogle Scholar
  16. 16.
    Petersen, L. A., Woodard, L. D., Urech, T., Daw, C., & Sookanan, S. (2006). Does pay-for-performance improve the quality of health care? Annals of Internal Medicine, 145(4), 265–272.PubMedCrossRefGoogle Scholar
  17. 17.
    Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O’Brien, M. A., & Oxman, A. D. (2006). Audit and feedback: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (2), CD000259. doi:10.1002/14651858.CD000259.pub2.
  18. 18.
    Fung, C. H., Lim, Y. W., Mattke, S., Damberg, C., & Shekelle, P. G. (2008). Systematic review: The evidence that publishing patient care performance data improves quality of care. Annals of Internal Medicine, 148(2), 111–123.PubMedCrossRefGoogle Scholar
  19. 19.
    Coulter, A., & Ellins, J. (2006). Patient-focused interventions. A review of the evidence. London: The Health Foundation.Google Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    Marshall, S., Haywood, K., & Fitzpatrick, R. (2006). Impact of patient-reported outcome measures on routine practice: A structured review. J Eval Clin Pract, 12(5), 559–568. doi:10.1111/j.1365-2753.2006.00650.x.PubMedCrossRefGoogle Scholar
  22. 22.
    Gilbody, S. M., House, A. O., & Sheldon, T. (2002). Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome–a systematic review. Psychological Medicine, 32(8), 1345–1356.PubMedCrossRefGoogle Scholar
  23. 23.
    Gilbody, S. M., House, A. O., & Sheldon, T. A. (2001). Routinely administered questionnaires for depression and anxiety: Systematic review. BMJ, 322(7283), 406–409.PubMedCrossRefGoogle Scholar
  24. 24.
    Valderas, J. M., Kotzeva, A., Espallargues, M., Guyatt, G., Ferrans, C. E., Halyard, M. Y., et al. (2008). The impact of measuring patient-reported outcomes in clinical practice: A systematic review of the literature. Quality of Life Research, 17(2), 179–193. doi:10.1007/s11136-007-9295-0.PubMedCrossRefGoogle Scholar
  25. 25.
    Department of Health & Children. (2001). Primary care: A new direction. Dublin: Government of Ireland.Google Scholar
  26. 26.
    Calman, K., & Hine, D. (1995). Policy framework for commissioning cancer services: A report by the expert advisory group on cancer to the chief medical officers of England and Wales. London: Department of Health.Google Scholar
  27. 27.
    Mental Health Commission. (2006). Multidisciplinary team working: From theory to practice- discussion paper, Dublin.Google Scholar
  28. 28.
    Smith, S., Cano, S., Lamping, D., Staniszewska, S., Browne, J., Lewsey, J., et al. (2005). Patient-reported outcome measures (PROMs) for routine use in treatment centres: Recommendations based on a review of the scientific evidence. London: Department of Health.Google Scholar
  29. 29.
    Robinson, K. A., & Dickersin, K. (2002). Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. International Journal of Epidemiology, 31(1), 150–153.PubMedCrossRefGoogle Scholar
  30. 30.
    Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J., Gavaghan, D. J., et al. (1996). Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clinical Trials, 17(1), 1–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Fayers, P. M. (2008). Evaluating the effectiveness of using PROs in clinical practice: A role for cluster-randomised trials. Quality of Life Research, 17(10), 1315–1321. doi:10.1007/s11136-008-9391-9.PubMedCrossRefGoogle Scholar
  32. 32.
    Cohen, J. (1969). Statistical power analysis for the behavioral sciences. New Jersey: Lawrence Arlnaum Associates Inc.Google Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    Dowrick, C., & Buchan, I. (1995). Twelve month outcome of depression in general practice: Does detection or disclosure make a difference? BMJ, 311(7015), 1274–1276.PubMedCrossRefGoogle Scholar
  35. 35.
    German, P. S., Shapiro, S., Skinner, E. A., Von Korff, M., Klein, L. E., Turner, R. W., et al. (1987). Detection and management of mental health problems of older patients by primary care providers. JAMA, 257(4), 489–493.PubMedCrossRefGoogle Scholar
  36. 36.
    Kazis, L. E., Callahan, L. F., Meenan, R. F., & Pincus, T. (1990). Health status reports in the care of patients with rheumatoid arthritis. Journal of Clinical Epidemiology, 43(11), 1243–1253.PubMedCrossRefGoogle Scholar
  37. 37.
    Mathias, S. D., Fifer, S. K., Mazonson, P. D., Lubeck, D. P., Buesching, D. P., & Patrick, D. L. (1994). Necessary but not sufficient: The effect of screening and feedback on outcomes of primary care patients with untreated anxiety. Journal of General Internal Medicine, 9(11), 606–615.PubMedCrossRefGoogle Scholar
  38. 38.
    Rubenstein, L. V., Calkins, D. R., Young, R. T., Cleary, P. D., Fink, A., Kosecoff, J., et al. (1989). Improving patient function: A randomized trial of functional disability screening. Annals of Internal Medicine, 111(10), 836–842.PubMedCrossRefGoogle Scholar
  39. 39.
    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), 607–614.PubMedCrossRefGoogle Scholar
  40. 40.
    White, P., Atherton, A., Hewett, G., & Howells, K. (1995). Using information from asthma patients: A trial of information feedback in primary care. BMJ, 311(7012), 1065–1069.PubMedCrossRefGoogle Scholar
  41. 41.
    Whooley, M. A., Stone, B., & Soghikian, K. (2000). Randomized trial of case-finding for depression in elderly primary care patients. Journal of General Internal Medicine, 15(5), 293–300.PubMedCrossRefGoogle Scholar
  42. 42.
    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. Eff Clin Pract, 2(1), 1–10.PubMedGoogle Scholar
  43. 43.
    Trowbridge, R., Dugan, W., Jay, S. J., Littrell, D., Casebeer, L. L., Edgerton, S., et al. (1997). Determining the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer. Academic Medicine, 72(9), 798–800.PubMedCrossRefGoogle Scholar
  44. 44.
    Lambert, M. J., Whipple, J. L., Smart, D. W., Vermeersch, D. A., & Nielsen, S. L. (2001). The effects of providing therapists with feedback on patient progress during psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11(1), 49–68.CrossRefGoogle Scholar
  45. 45.
    Hawkins, E. J., Lambert, M. J., Vermeersch, D. A., Slade, K. L., & Tuttle, K. C. (2004). The therapeutic effects of providing patient progress information to therapists and patients. Psychotherapy Research, 14(3), 308–327.CrossRefGoogle Scholar
  46. 46.
    McCoy, J. M., Rubenstein, L., Hirsch, S. H., & Barrett, P. A. (1988). A feedforward system for functional status information. Proceedings of the Annual Symposium on Computer Applications in Medical Care, 9, 683–686.Google Scholar
  47. 47.
    Puschner, B., Schöfer, D., Knaup, C., & Becker, T. (2009). Outcome management in in-patient psychiatric care. Acta Psychiatrica Scandinavica, 120(4), 308–319.PubMedCrossRefGoogle Scholar
  48. 48.
    Gutteling, J. J., Darlington, A. S., Janssen, H. L., Duivenvoorden, H. J., Busschbach, J. J., & de Man, R. A. (2008). Effectiveness of health-related quality-of-life measurement in clinical practice: A prospective, randomized controlled trial in patients with chronic liver disease and their physicians. Quality of Life Research, 17(2), 195–205. doi:10.1007/s11136-008-9308-7.PubMedCrossRefGoogle Scholar
  49. 49.
    Weingarten, S. R., Kim, C. S., Stone, E. G., Kristopaitis, R. J., Pelter, M., & Sandhu, M. (2000). Can peer-comparison feedback improve patient functional status? American Journal of Managed Care, 6(1), 35–39.PubMedGoogle Scholar
  50. 50.
    Berking, M., Orth, U., & Lutz, W. (2006). How effective is systematic feedback of treatment progress to the therapist? An empirical study in a cognitive-behavioural- oriented inpatient setting. Zeitschrift fur Klinische Psychologie und Psychotherapie, 35, 21–29.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Department of Epidemiology and Public HealthUniversity College CorkCorkIreland

Personalised recommendations