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Value Health. 2015 Jun;18(4):493-504. doi: 10.1016/j.jval.2015.02.018. Epub 2015 May 21.

Methods for Developing Patient-Reported Outcome-Based Performance Measures (PRO-PMs).

Author information

  • 1University of North Carolina, Chapel Hill, NC, USA. Electronic address:
  • 2University of Missouri, Kansas City, MO, USA.
  • 3University of California, San Francisco, San Francisco, CA, USA.
  • 4Johns Hopkins School of Public Health, Baltimore, MD, USA.
  • 5Mayo Clinic, Rochester, MN (Patient Representative), USA.
  • 6Parkinson Pipeline Project, Washington, DC (Patient Representative), USA.
  • 7Research Advocacy Network, Plano, TX (Patient Representative), USA.
  • 8London School of Hygiene and Tropical Medicine, London, England.
  • 9American Medical Association, Chicago, IL, USA.
  • 10Palmer College of Chiropractic, Davenport, IA, USA.



To recommend methods for assessing quality of care via patient-reported outcome-based performance measures (PRO-PMs) of symptoms, functional status, and quality of life.


A Technical Expert Panel was assembled by the American Medical Association-convened Physician Consortium for Performance Improvement. An environmental scan and structured literature review were conducted to identify quality programs that integrate PRO-PMs. Key methodological considerations in the design, implementation, and analysis of these PRO-PM data were systematically identified. Recommended methods for addressing each identified consideration were developed on the basis of published patient-reported outcome (PRO) standards and refined through public comment. Literature review focused on programs using PROs to assess performance and on PRO guidance documents.


Thirteen PRO programs and 10 guidance documents were identified. Nine best practices were developed, including the following: provide a rationale for measuring the outcome and for using a PRO-PM; describe the context of use; select a measure that is meaningful to patients with adequate psychometric properties; provide evidence of the measure's sensitivity to differences in care; address missing data and risk adjustment; and provide a framework for implementation, interpretation, dissemination, and continuous refinement.


Methods for integrating PROs into performance measurement are available.


PRO-PM; patient-reported outcome; performance measurement; quality

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