The use of aggregate (i.e., practice wide) patient-reported outcome measurement (PROM) for program evaluation and quality improvement is nothing new in behavioral healthcare. Hospitals, large healthcare organizations, and university health centers have leveraged the power of aggregate outcome data for decades to aid in refining their practices and protocols for improving the health and wellness of the individuals they serve.
However, the benefits of using aggregate data has been slow to disseminate into routine clinical practice for the small guys - clinicians in private or small group practices. This phenomenon has traditionally been a result of the logistical difficulties in collecting and analyzing PROMs via paper-pencil format. Anyone who has administered and hand scored an outcome measure during a therapy session is well aware that this method is difficult to keep up with at the individual level, much less when trying to combine, compare, and make sense of this data across your clinic’s caseload.
With the advent of technology platforms which ease the burden of collecting, scoring, and managing PROMs, private and group practices are now able to take advantage of this powerful and insightful data that has previously been inaccessible. Below are five ways that private and group practice can use aggregate PROMs for improving their practice.
1. Quantify clinic performance
You have worked hard to build your practice and provide quality care for the patients that you serve. Whether you practice EMDR for healing trauma, CBT for battling depression, or FFT for improving family functioning, you do what you do for the single purpose of helping your clients live a better life. This concept of beneficence - doing good - is even baked into our ethics code as a fundamental principal by which we all should adhere to.
The first and foremost way to use aggregate PROMs in your practice is to quantify this hard work by elucidating the extent to which your patients are improving. That is, looking at change in patient improvement across all patients that walk through your door. Although we may already know in general how well each patient is improving through our interactions with them during session, there is an additional quality that comes with quantifying this experience. Elucidating clinical performance helps validate that your approach is working, and can be especially rewarding when visualized through charts and graphs.
2. Identify vulnerable patient groups
Even among top-performing therapists or practices, there are bound to be certain patients or populations who, for whatever reason, do not respond favorably to your services. The ability to identify these groups accurately and swiftly is the first step in better understanding how you can adjust your approach or protocols to meet the needs of this vulnerable population.
The use of clinic-wide outcome data is a wonderful way of streamlining this process. Aggregate PROMs can be used to help identify contextual variables (e.g., age, gender, presenting problem, severity of illness) that are associated with a lack of treatment response which, in turn, can inform future program development and quality improvement (mentioned below). In fact, considering the cultural biases and limited generalizability that many evidence-based practices are subject to, keeping an eye on populations who may not be benefitting from your services should be routine practice for any private or group practice.
3. Evaluate program changes
Once you start learning more about your practice through the use of aggregate PROMs, you will begin to understand what aspects of your care might need to be updated or modified based on this information. A fundamental component to any program development effort is the ability to validate whether or not it was effective or produced the result that was intended.
When it comes to program changes in private or group practice, this may take the form of changing a theoretical orientation, adding a new consultation/collaboration model, or even adding a new type of approach or protocol to your treatment repertoire. Whatever it might be, comparing outcomes across your practice before and after the change occurred is a wonderful strategy for determining if the change added value to your clinical practice. In an interactive process, you can double-down on programmatic changes that were effective, and ditch the ones that were not.
4. Identify highly-effective clinicians in your practice
Some clinics may be interested in identifying which clinicians in their practice are most effective at producing positive change among the patients they work with. For some, this idea may initially evoke a sense of skepticism and concern - and for good reason! We are trained to be empathetic and non-judgmental toward the individuals we interact with, and our own colleagues are no exception. However, if implemented properly and in the spirit of collaboration and learning, it can also be quite powerful.
Using aggregate PROMs to identify individuals in your clinic who tend to provide exceptional outcomes can lead to incredibly insightful conversations and didactic experiences related to what they may be doing differently from the rest of us. In fact, this ability for self-evaluation and flexibility in practice is a keystone predictor of therapists who tend to improve in their effectiveness over the course of their career.
5. Track personal growth
Let’s face it - a life in private or group practice can sometimes lead to a feeling of doing the same thing time and time again. Pushing yourself to be a lifelong learner and keep up with the noteworthy developments in your field is an important step in maintaining competence as a clinician in private or group practice. In this way, evaluating aggregate data from PROMs on a quarterly or yearly basis can be another avenue to pursue personal growth in the work that you do.
Along with evaluating your effeteness more generally at different stages of your career, using aggregate PROMs to track your effectiveness over time can be an immensely motivating practice to keep pushing yourself and challenging the ways in which you provide care. With self-evaluation comes personal growth.
