Incorporating Health Status in Routine Care to Improve Health Care Value: The VA Patient Reported Health Status Assessment (PROST) System.

For more than 2 decades, performancemeasurementhas beenusedtoincentivizeimprovementsinhealthcarequality. However, performance measures have largely focused on care processes that can be weakly linked to patient outcomes,andtheproliferationofthesemeasureshasbecome a potential barrier to further quality improvement.1 Refocusingperformancemeasuresonhealthoutcomesthatreflect the patient’s perspective may help reduce measurement burden and incentivize care delivery improvements that directly improve patient health. Standardized measures of patient-reported health status (including symptoms, functional status, and health-related quality of life) offeravalid,sensitive,andreproducibleapproachtoassess healthoutcomesfromthepatient’sperspective,2 butthese measures are infrequently captured in clinical care. Understanding patient-reported health status is also central to the United States’ transition from a volumebased to a value-based reimbursement system. Elective percutaneous coronary intervention (PCI) for stable ischemic heart disease serves as a prototypical example. In 2008, nearly 200 000 Medicare beneficiaries received elective PCI for stable coronary disease, with associated payments exceeding $2 billion.3 Although the purpose of elective PCI is to reduce patients’ symptoms and improve angina-relatedqualityoflife,theimprovementsinpatients’ health status from these procedures using standardized measures are not routinely quantified in clinical practice, thereby limiting the ability to define the value (ie, patient outcomes relative to the cost of care) of these procedures. To overcome this challenge, the National Quality Forum has issued guidance on the importance of measuring patient-reported outcomes to achieve performance improvement.4 Further, the Centers for Medicare & Medicaid Services has begun to develop quality measures for elective PCI based on validated patient-reported health status measures. Although these efforts crystalize the importance of patient-reported health status in the measurement of health care quality and value, it remains unclear how patient-reported health status should be collected without disrupting clinical workflow and how these measures should be used to improve patient health. In this Viewpoint, we describe the early efforts of the US Department of Veterans Affairs (VA) Patient Reported Health Status Assessment (PROST) system to capture, report, and initiate clinical action in response to patientreported health status measures and improve the value of care delivered to veterans undergoing elective PCI. Although initially focused on PCI, the PROST system is a possible model of how to measure and improve the value of health care that seeks to optimize patient health status.