The Patient Experience: An Essential Component of High-Value Care and Service



The US currently spends approximately $750 billion on health care each year, a spending rate deemed highly unsustainable by economists. Efforts to fundamentally transform healthcare delivery into a value-based system are currently under way. High-value care aims to control unnecessary healthcare expenditures by focusing on the value of healthcare interventions and services determined by evaluating the costs in light of benefits and risks while considering quality care outcomes that are prioritized by patients. In short, value equals quality divided by cost. Patients play an active and important role in both the practice and evaluation of quality in the delivery of high-value care. One way to measure quality involves an evaluation of patient-reported outcomes (PROs). PROs are representations of how patients feel and/or their functional abilities within the context of their own health and daily life in a number of domains (physical and emotional health, functional status, symptoms, and symptom burden). This chapter provides an overview of high-value care largely focusing on the role of the patient and the patient’s perspective. Lastly, PROs are discussed and specific tools used for PRO measurement are highlighted.


High-value care Patient perspective Patient-reported outcomes Healthcare reform Healthcare quality Shared decision-making Patient-centered care 



Alliance for Academic Internal Medicine


American College of Physicians


Agency for Healthcare Research and Quality


American Recovery and Reinvestment Act


Consumer Assessment of Healthcare Providers and Systems


Comparative effectiveness research


Functional Assessment of Chronic Illness Therapy


Hospital Consumer Assessment of Healthcare Providers and Systems


Health-related quality of life


High-value care


National Comprehensive Cancer Network


Patient-Centered Outcomes Research Institute


Patient-reported outcomes


Patient Reported Outcomes Measurement Information System


Patient Reported Outcome Measures


Spine Patient Outcomes Research Trial


  1. 1.
    Institute of Medicine. The healthcare imperative: lowering costs and improving outcomes: workshop series summary. Washington, DC: National Academies Press; 2010.Google Scholar
  2. 2.
    Weinberger SE. Providing high-value, cost-conscious care: a critical seventh general competency for physicians. Ann Intern Med. 2011;155(6):386–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Qaseem A, Alguire P, Dallas P, Feinberg LE, Fitzgerald FT, Horwitch C, et al. Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Ann Intern Med. 2012;156(2):147–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Owens DK, Qaseem A, Chou R, Shekelle P. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med. 2011;154(3):174–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Porter ME, Pabo EA, Lee TH. Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs. Health Aff. 2013;32(3):516–25.CrossRefGoogle Scholar
  6. 6.
    Institute for Strategy & Competitiveness Harvard Business School. Value-based health care delivery—measuring and managing costs. n.d.
  7. 7.
    Porter ME. A strategy for health care reform—toward a value-based system. N Engl J Med. 2009;361(2):109–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Boston: Harvard Business School Press; 2006.Google Scholar
  9. 9.
    Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89(9):46–52.PubMedGoogle Scholar
  11. 11.
    American College of Physicians. High value care. 2016.
  12. 12.
    Chou R, Qaseem A, Owens DK, Shekelle P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154(3):181–9.CrossRefPubMedGoogle Scholar
  13. 13.
    American College of Physicians. High value care: curriculum for educators and residents. n.d.
  14. 14.
    Sox HC, Greenfield S. Comparative effectiveness research: a report from the Institute of Medicine. Ann Intern Med. 2009;151(3):203–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Mayo Clinic. A foundation for health care reform legislation: Mayo Clinic’s point of view. 2008.Google Scholar
  16. 16.
    Porter ME, Lee TH. The strategy that will fix health care. Harv Bus Rev. 2013;91(12):24.Google Scholar
  17. 17.
    Porter ME. Measuring health outcomes: the outcomes hierarchy. N Engl J Med. 2010;363:2477–81.CrossRefPubMedGoogle Scholar
  18. 18.
    Flink M, Hesselink G, Barach P, Öhlen G, Wollersheim H, Pijneborg L, Hansagi H, Vernooij-Dassen M, Olsson M. The key actor: a qualitative study of patient participation in the handover process in Europe. BMJ Qual Saf. 2012:1–8. doi: 10.1136/bmjqs-2012-001171.
  19. 19.
    Barach P, Lipshultz S. The beneifts and hazards of publicly reported quality outcomes. Prog Pediatr Cardiol. 2016:45–9. doi: 10.1016/j.ppedcard.2016.06.001.
  20. 20.
    Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood E, Abdu WA, et al. Surgical versus non-operative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine. 2008;33(25):2789.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358(8):794–810.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, et al. Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. J Bone Joint Surg. 2009;91(6):1295–304.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, et al. Surgical versus non-operative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine. 2010;35(14):1329.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Tosteson AN, Tosteson TD, Lurie JD, Abdu W, Herkowitz H, Andersson G, et al. Comparative effectiveness evidence from the spine patient outcomes research trial: Surgical vs. non-operative care for spinal stenosis, degenerative spondylolisthesis and intervertebral disc herniation. Spine. 2011;36(24):2061.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Bohmer RM. The four habits of high-value health care organizations. N Engl J Med. 2011;365(22):2045–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.Google Scholar
  27. 27.
    Boss EF, Mehta N, Nagarajan N, Links A, Benke JR, Berger Z, et al. Shared decision making and choice for elective surgical care a systematic review. Otolaryngol Head Neck Surg. 2015;153:405–20. doi: 10.1177/0194599815620558.Google Scholar
  28. 28.
    Barry MJ, Edgman-Levitan S. Shared decision making—the pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1.CrossRefPubMedGoogle Scholar
  29. 29.
    Coulter A, Collins A. Making shared decision-making a reality. London: King’s Fund; 2011.Google Scholar
  30. 30.
    Flink M, Ohlen G, Hansagi H, Barach P, Olsson M. Beliefs and experiences can influence patient participation in handover between primary and secondary care—a qualitative study of patient perspectives. BMJ Qual Saf. 2012:1–8. doi: 10.1136/bmjqs-2012-001179.
  31. 31.
    Selby JV, Beal AC, Frank L. The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. JAMA. 2012;307(15):1583–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Agency for Healthcare Research and Quality. The SHARE Approach. Rockville. 2015
  33. 33.
    Informed Medical Decisions Foundation. Shared decision making resources. n.d.
  34. 34.
    Hoffmann TC, Del Mar C. Patients’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review. JAMA Intern Med. 2015;175(2):274–86.CrossRefPubMedGoogle Scholar
  35. 35.
    Korenstein D. Patient perception of benefits and harms: the achilles heel of high-value care. JAMA Intern Med. 2015;175(2):287–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Weinstein JN, Clay K, Morgan TS. Informed patient choice: patient-centered valuing of surgical risks and benefits. Health Aff. 2007;26(3):726–30.CrossRefGoogle Scholar
  37. 37.
    Eden KB, Scariati P, Klein K, Watson L, Remiker M, Hribar M, et al. Mammography decision Aid reduces decisional conflict for women in their forties considering screening. J Womens Health. 2015;24(12):1013–20.CrossRefGoogle Scholar
  38. 38.
    Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011;10, CD001431.Google Scholar
  39. 39.
    Weinstein JN, Brown PW, Hanscom B, Walsh T, Nelson EC. Designing an ambulatory clinical practice for outcomes improvement: from vision to reality-the Spine Center at Dartmouth-Hitchcock, year One. Qual Manag Health Care. 2000;8(2):1–20.CrossRefPubMedGoogle Scholar
  40. 40.
    Vegas DB, Levinson W, Norman G, Monteiro S, You JJ. Readiness of hospital-based internists to embrace and discuss high-value care with patients and family members: a single-centre cross-sectional survey study. CMAJ Open. 2015;3(4), E382.CrossRefGoogle Scholar
  41. 41.
    Sommers R, Goold SD, McGlynn EA, Pearson SD, Danis M. Focus groups highlight that many patients object to clinicians’ focusing on costs. Health Aff. 2013;32(2):338–46.CrossRefGoogle Scholar
  42. 42.
    Hesselink G, Flink M, Olsson M, Barach P, Vernooij-Dassen M, Wollersheim H. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Qual Saf. 2012;21 Suppl 1:i29–49. doi: 10.1136/bmjqs-2012-00116.
  43. 43.
    Ahmed F, Burt J, Roland M. Measuring patient experience: concepts and methods. Patient. 2014;7(3):235–41.CrossRefPubMedGoogle Scholar
  44. 44.
    Cosgrove DM, Fisher M, Gabow P, Gottlieb G, Halvorson GC, James BC, et al. Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs. Health Aff. 2013;32(2):321–7.CrossRefGoogle Scholar
  45. 45.
    Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229–39.CrossRefPubMedGoogle Scholar
  46. 46.
    Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care. 2011;17(1):41–8.PubMedGoogle Scholar
  47. 47.
    Epstein RM, Franks P, Shields CG, Meldrum SC, Miller KN, Campbell TL, et al. Patient-centered communication and diagnostic testing. Ann Fam Med. 2005;3(5):415–21.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Price RA, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014;71(5):522–54.CrossRefGoogle Scholar
  49. 49.
    Acquadro C, Berzon R, Dubois D, Leidy NK, Marquis P, Revicki D, et al. Incorporating the patient’s perspective into drug development and communication: an ad hoc task force report of the patient‐reported outcomes (PRO) harmonization group meeting at the Food and Drug Administration, February 16, 2001. Value Health. 2003;6(5):522–31.CrossRefPubMedGoogle Scholar
  50. 50.
    Cella D, Hahn EA, Jensen SE, Butt Z, Nowinski CJ, Rothrock N, et al. Patient-reported outcomes in performance measurement. Research Triangle Park: RTI Press; 2015.CrossRefGoogle Scholar
  51. 51.
    Kotronoulas G, Kearney N, Maguire R, Harrow A, Di Domenico D, Croy S, et al. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol. 2014;32(14):1480–501.CrossRefPubMedGoogle Scholar
  52. 52.
    Søreide K, Søreide AH. Using patient-reported outcome measures for improved decision-making in patients with gastrointestinal cancer–the last clinical frontier in surgical oncology? Front Oncol. 2013;3:157.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Patient Reported Outcomes Measurement Information System. n.d.
  54. 54.
    Cella D, Lai J-S, Nowinski C, Victorson D, Peterman A, Miller D, et al. Neuro-QOL Brief measures of health-related quality of life for clinical research in neurology. Neurology. 2012;78(23):1860–7.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
  56. 56.
    Cleeland CS. Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr. 2007;37:16.CrossRefGoogle Scholar
  57. 57.
    Amtmann D, Cook KF, Jensen MP, Chen W-H, Choi S, Revicki D, et al. Development of a PROMIS item bank to measure pain interference. Pain. 2010;150(1):173–82.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997;13(2):63–74.CrossRefPubMedGoogle Scholar
  59. 59.
    Smith E, Lai J-S, Cella D. Building a measure of fatigue: the functional assessment of Chronic Illness Therapy Fatigue Scale. Phys Med Rehabil. 2010;2(5):359–63.Google Scholar
  60. 60.
    Yount SE, Choi SW, Victorson D, Ruo B, Cella D, Anton S, et al. Brief, valid measures of dyspnea and related functional limitations in chronic obstructive pulmonary disease (COPD). Value Health. 2011;14(2):307–15.CrossRefPubMedGoogle Scholar
  61. 61.
    Rosenbloom S, Yount S, Yost K, Hampton D, Paul D, Abernethy A, et al. Development and validation of eleven symptom indices to evaluate response to chemotherapy for advanced cancer: measurement compliance with regulatory demands. In: Farquhar I, Summers K, Sorkin A, editors. The value of innovation: impacts on health, life quality, and regulatory research, Research in human capital and development, vol. 16. Bingley: Emerald Group Publishing Limited; 2008.Google Scholar
  62. 62.
    Cella D, Rosenbloom SK, Beaumont JL, Yount SE, Paul D, Hampton D, et al. Development and validation of 11 symptom indexes to evaluate response to chemotherapy for advanced cancer. J Natl Compr Canc Netw. 2011;9(3):268–78.CrossRefPubMedGoogle Scholar
  63. 63.
    Hall JA, Dornan MC. Meta-analysis of satisfaction with medical care: description of research domain and analysis of overall satisfaction levels. Soc Sci Med. 1988;27(6):637–44.CrossRefPubMedGoogle Scholar
  64. 64.
    Lewis JR. Patient views on quality care in general practice: literature review. Soc Sci Med. 1994;39(5):655–70.CrossRefPubMedGoogle Scholar
  65. 65.
    Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann. 1983;6(3–4):185–210.CrossRefPubMedGoogle Scholar
  66. 66.
    Williams B. Patient satisfaction: a valid concept? Soc Sci Med. 1994;38(4):509–16.CrossRefPubMedGoogle Scholar
  67. 67.
    Oberst MT. Methodology in behavioral and psychosocial cancer research. Patients’ perceptions of care. Measurement of quality and satisfaction. Cancer. 1984;53(10 Suppl):2366.CrossRefPubMedGoogle Scholar
  68. 68.
    Speight J. Assessing patient satisfaction: concepts, applications, and measurement. Value Health. 2005;8(s1):S6–8.CrossRefPubMedGoogle Scholar
  69. 69.
    Ware JE, Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Eval Program Plann. 1983;6(3):247–63.CrossRefPubMedGoogle Scholar
  70. 70.
    Lehrman WG, Friedberg MW. CAHPS surveys: valid and valuable measures of patient experience. Hastings Cent Rep. 2015;45(6):3–4.CrossRefPubMedGoogle Scholar
  71. 71.
    Luxford K. What does the patient know about quality? Int J Qual Health Care. 2012;24(5):439–40. doi: 10.1093/intqhc/mzs053.CrossRefPubMedGoogle Scholar
  72. 72.
    Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1), e001570.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Black N, Varaganum M, Hutchings A. Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf. 2014;23(7):534–42. doi: 10.1136/bmjqs-2013-002707.CrossRefPubMedGoogle Scholar
  74. 74.
    Agency for Healthcare Research and Quality. The CAHPS Program n.d.
  75. 75.
    Centers for Medicare and Medicaid Services. HCHAPS: Patients’ Perspectives of Care Survey. 2014.
  76. 76.
    Mayer EK, Chow A, Vale JA, Athanasiou T. Appraising the quality of care in surgery. World J Surg. 2009;33(8):1584–93.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Medical Social SciencesNorthwestern UniversityChicagoUSA
  2. 2.Medical Social Sciences and Psychiatry & Behavioral SciencesRobert H. Lurie Comprehensive Cancer Center of Northwestern UniversityChicagoUSA
  3. 3.Medical Social SciencesNorthwestern University, Feinberg School of MedicineChicagoUSA

Personalised recommendations