Towards quality-oriented and patient-centered health care

The German Ethics Council identifies an orientation toward patient welfare and quality of life to be an imperative in health care. This includes providing care that enables patient self-determination, high-quality treatment, equal access and a needs-oriented allocation of facilities and resources. All healthcare structures and processes should be consistently oriented toward patient welfare and quality of life.

However, and contrary to what one might expect, there is no attempt in Germany to systematically examine patients’ feedback on their care experiences and outcomes. Several other countries have already made gains in this respect by collecting patient-reported outcomes digitally through systematic surveys and using this data to improve health care in general (see our “PROMS – an International Comparison” study).

In addition to clinical and administrative data, patient surveys are an important additional source of data to measure and assess the quality of care. With patient-reported outcome measure (PROMs), patients’ self-assessed health status can be measured and compared before, during and after treatment. This involves using validated instruments, survey periods and rating scales. PROMs thus provide an objective means of tracking how medical interventions influence patients’ health status and the extent to which they improve their daily life.

Furthermore, collecting information on patients’ experience of the treatment process through patient-reported experience measures (PREMs) can provide important data on aspects of quality of care such as patient safety, communication and coordination, which fosters patient-centered care. As event- and fact-driven instruments, PREMs are not satisfaction ratings.

In combination with clinician-reported data, patient-reported data provide a comprehensive overview of the quality of care in our healthcare system. They are particularly useful in the context of individual medical interventions, but are also relevant for quality control efforts and evidence generation. Collected digitally, evaluated in real time, and fed back to the treating physician, PROMs provide information on how a patient is currently doing. They thus help track patients’ health status and can, for example, make it easier to rapidly adapt ongoing treatment quickly as needed, improve physician-patient communication and strengthen patient empowerment.

With regard to the healthcare system as such, aggregated PROMs can improve efforts to understand the impact of different types of care and procedures, thereby fostering campaigns to improve the quality of care. They can be used to further develop treatment pathways and guidelines, and they can be used for external quality assurance or public reporting purposes. PROMs are also used as endpoints in clinical trials.

An outcome-driven and patient-centered focus is gaining ground in Germany’s healthcare system. However, Germany has yet to introduce a dedicated strategy and regulatory framework for the implementation of standardized patient-reported experience and outcome measures. There are some good examples of PROMs and PREMs currently being applied, primarily under the direction of individual physicians or clinics who believe in the benefits of these instruments. Given that the systematic collection of patient-reported data is crucial to ensuring patient-centered care in our healthcare system, we work to support the introduction of patient-reported outcome and experience measures in Germany. We build the bridges needed between stakeholders in the field and in politics, while developing and communicating ideas for practical application. In our view, PROMs and PREMs are essential to making the transformative shift toward a quality-oriented and patient-centered healthcare system.