The Economist (Intelligence Unit) – Creating Healthy Partnerships (2019)

THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED

CARE IN HEALTH SYSTEMS

Table 9: Use of patient empowerment assessment tools by healthcare providers

Indicator Sub-indicator Brazil China France Germany Italy Japan Spain UK US

Patient

empowerment

Use of patient

empowerment assessment

tools by healthcare

providers

0 0 0 0 0 0 0 1 1

0 = No/Not reported; 1 = Use of patient empowerment assessment tools by health providers.

Chapter 5: Metrics and data gathering urgently needed

No date for the PROMs

The truism that you get what you measure for is as accurate in healthcare as elsewhere. A crucial early
step towards patient-centred care, Mr Graham of the Picker Institute observes, is trying to capture
people’s experiences in order to create a baseline of the existing situation and a rationale for change.
Without “good systematic measures, you rarely get critical improvement”.

Patient groups agree. In our survey, a majority of respondents cited a focus on outcomes that matter as
a leading element of patient-centred care, well ahead of even patient experience and shared decision-
making.

In our scorecard, however, indicators related to measurements of different aspects of patient-
centricity have some of the worst results across countries. For example, we found evidence of health
systems using patient empowerment assessment tools only in the UK and US (see Table 9), while
Germany joined these two as the sole countries that had clearly deployed at least some metrics around
the quality of shared decision-making support (see Table 3).

The most striking result concerns PROMs, especially given the attention that these metrics have
received in recent years. PROMs are tools—typically validated, standardised questionnaires—through
which patients give their assessment of any number of treatment results, from relief or not of given
physical and mental symptoms, through the individual’s functional status, to health-related quality of
life. The questionnaires can be either general or condition-specific and normally are repeated before
and after (sometime more than once) an intervention to give an idea of its impact.^41

In short, PROMs transform the definition of a treatment’s success from whether it changed measurable
biomedical outcomes chosen by the health system to if, and how much, it made the patient feel better.
This makes them fundamental to patient-centred care.

41 For further detail, see Charlotte Kingsley

and Sanjiv Patel, “Patient-reported

outcome measures and patient-reported

experience measures,” BJA Education, 2017

and Theresa Weldring and Sheree Smith,

“Patient-Reported Outcomes (PROs) and

Patient-Reported Outcome Measures

(PROMs),” Health Services Insights, 2013.