Have you ever had a patient who did great in therapy, but their test scores were flat? Ever had a patient who didn’t “get” what you were trying to do? Ever cringe at out-dated assessment materials? If so, consider using a patient-reported outcome measure (PROM) for your initial assessment and goal setting. Using PROMs for person-centered care offers a lot of great benefits. The information in this post comes from two informative and resource-packed CEU courses by Sarah Baar (SLP) on Medbridge.
Free DIRECT download: PROMs & person-centered care (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- Person-centered care, defined.
- Two excellent Medbridge courses.
- Potential problems with “standardized tests”.
- What are PROMs?
- What are the benefits of using PROMs?
- CMS recommends using PROMs for person-centered care.
- What if there’s not a PROM for that? Self-Anchored Rating Scales.
- It’s time for SLPs to step back and see the forest.
- Related Eat, Speak, & Think posts.
- References.
Person-centered care, defined
According to the Centers for Medicare & Medicaid Services (CMS), when medical professionals successfully deliver person-centered care, we provide services that are:
…”responsive to individuals and their goals, values and preferences, in a system that supports good provider-patient communication and empowers individuals receiving care and providers to make effective care plans together.”
CMS.gov
CMS goes on to say that in order for clinicians to be successful at person-centered care, we must:
- Be guided and informed by patient’s goals, preferences, and values.
- Show success using patient-reported outcomes.
- Coordinate our care with other providers and settings.
- Manage chronic and complex conditions.
- Build relationships based on trust and a commitment to long-term well-being.
I think SLPs all want to provide person-centered care, but we may not know how to do that in practice.
Two excellent Medbridge courses
I recently took two Medbridge courses taught by Sarah Baar (SLP). I highly recommend both courses, which complement each other without overlapping significantly.
- The Forest or the Trees: Goals and Documentation in Adult Rehab* – 0.1 CEU.
- Meaningful Goals Just Got Easier: Patient-Reported Outcome Measures* – 0.2 CEUs.
*This is an affiliate link. At no extra cost to you, you can help keep Eat, Speak, & Think sustainable if you subscribe through this link or use the code EatSpeakThink. Learn more about the discount.
Sarah is clearly knowledgeable and passionate about delivering person-centered care and thinking about the bigger picture. She shares tons of clear, practical, actionable information. (I have 8 pages of single-spaced typed notes for the 3 hours of lecture!)
Each course includes supporting research, example goals, videos of real patients where Sarah is modeling some aspect of using PROMs for person-centered care, and resources to help us with our clinical practice. (I didn’t notice an overlap in resources.)
In this article, I’m sharing just a small slice of the information she taught. My goal is to encourage you to consider PROMs in your clinical practice, or to help you use them more effectively.
Potential problems with “standardized tests”
When SLPs hear the term “standardized measures”, we generally think of big, expensive tests like the the WAB or the FAVRES. These tests are one type of standardized measure, called norm-referenced tests. When we administer a test of this type, we’re comparing the performance of our patient against that of a group of people. (Some standardized tests are both norm-referenced and criterion-referenced, like the BDAE-3.)
In the “Forest or the Trees” course, Sarah points out a number of potential problems with norm-referenced, standardized tests:
- Norm-referenced tests generally aren’t normed on a diverse population.
- Supports an impairment-based approach to therapy.
- Aren’t generally sensitive enough to capture meaningful real-life improvements as a result of therapy.
Sarah uses the analogy of not being able to see the whole person (the forest) because we traditionally have been focused impairments as measured by standardized tests (the trees). She says we’re missing an opportunity to demonstrate the improvement our patients make. So what’s another option? PROMs.
What are PROMs?
Patient-reported outcome measures (PROMs) belong to the other type of standardized measure: criterion-referenced standardized measure. Criterion-referenced measures compare our patient against a predetermined standard, instead of how a selected group of people.
PROMs are a type of standardized and validated questionnaires that allow our patients to report on their own experience.
In the “Forest or Trees” course, Sarah shared that each PROM is different and may measure any of the following, from the patient’s perspective:
- Confidence.
- Participation.
- Satisfaction.
- Efficiency.
- Quality of Life.
- Use of strategies or supports.
- Activities that are challenging.
There are many PROMs we can choose from. A few examples include:
- Eating Assessment Tool (EAT-10).
- The Neuro-QoL Cognitive Function Short Form.
- Multifactorial Memory Questionnaire (MMQ).
In her “Meaningful Goals” course, Sarah shared a clearinghouse for freely available PROMs, a site that I use as well: HealthMeasures.net. We can find many PROMs for speech therapy under the PROMIS and Neuro-QoL systems.
What are the benefits of using PROMs?
In her “Forest or Trees” course, Sarah shares several benefits of using PROMs, including:
- Our patient reports on their own experience, free from implicit bias from the clinician.
- The PROM gives some structure to our interview and can help us identify goals.
- Our patient has a better understanding of their choices for goals for therapy.
- Speech therapy goals make more sense to our patient.
- Therapy targets real-life activities meaningful to each specific patient.
- Helps SLPs discuss progress in relatable terms, making speech therapy more relevant to other medical providers.
- Last but not least, CMS is pushing for clinicians to use PROMs.
CMS recommends using PROMs for person-centered care
CMS is arguably the most important agency in the US for setting rehabilitation policy. Many of us work with clients who have these insurances. Additionally, the policies of CMS are often adopted by private/commercial insurance. So, for those of us working in the USA, it’s smart to pay attention to their strategic goals.
Unlike Sarah, I don’t enjoy reading CMS publications, but I appreciate her enthusiasm! And I especially appreciate her taking the time in her “Meaningful Goals” course to share what CMS is up to with the push for using PROMs.
Sarah gives a good explanation which is well worth listening to, and I couldn’t do it justice. But my high-level take-away is that CMS is emphasizing the use of PROMs as part of its push for value-based care. One reason is to promote “equitable outcomes through high-quality, affordable, person-centered care.”
Using PROMs seems to be a win-win-win: our patients receive person-centered care, we help our patients achieve meaningful outcomes, and CMS supports high-quality, efficient care with our tax money.
What if there’s not a PROM for that? Self-Anchored Rating Scales
What happens when we can’t find a PROM that targets what our patient’s specific concern?
In her “Forest or Trees” course, Sarah shared the example of a patient who returned to work after a brain injury. The woman was frustrated, because she felt like she was being left out of loop and had lost her “professional polish.”
There’s not likely a PROM that would target that specific situation.
Sarah taught that self-anchored rating scales (SARS) are a tool we can use if we want to customize a measure for our patient.
Basically, a SARS is a 1-10 scale in which the patient identifies the meaning of each end-point. Our patient decides what to measure and what progress looks like. They can rate their skill, efficiency, use of strategies/supports, participation, satisfaction, quality of life, ease, or confidence – whatever they’d like.
We can use their initial score as their baseline and write a goal to improve it by the end of therapy. Or, if there’s a progressive disease, the goal could be to maintain the score over time.
Sarah does a great job explaining SARS, giving specific examples and goals, and showing videos of her with real patients.
It’s time for SLPs to step back and see the forest
Healthcare is constantly changing, and now it’s moving towards caring for people in a way that makes sense to them. For us, it means looking up from our standardized, norm-referenced tests to look at the whole person. Using PROMs allows our patients to share their own experience, separate from our implicit bias. We can work on goals that are truly meaningful for our patients, and capture the progress we make in our final reports.
I encourage you to check out Sarah Baar’s courses on Medbridge. She shares a wealth of knowledge, practical tips, and helpful resources.
I also recommend that you check out the PROMIS and Neuro-QoL PROMs on HealthMeasures.net. Please share what you learn with your colleagues! Every step we take moves us closer to providing patient-centered care in an equitable manner for all of our patients.
Related Eat, Speak, & Think posts
- Goal Attainment Scaling tutorial.
- 35+ free cognitive tests, screeners, and questionnaires.
- Write better cognitive goals with 54 daily activities.
References
- Baar, S. (n.d.). Meaningful Goals Just Got Easier: Patient-Reported Outcome Measures. Medbridge. Retrieved on October 7, 2023, from https://www.medbridge.com/courses/details/meaningful-goals-just-got-easier-patient-reported-outcome-measures-recorded-webinar
- Baar, S. (n.d.). The Forest or the Trees: Goals and Documentation in Adult Rehab. Medbridge. Retrieved on October 7, 2023, from https://www.medbridge.com/courses/details/the-forest-or-the-trees-goals-and-documentation-in-adult-rehab-sarah-baar
- Renaissance. (2018, July 11). What’s the difference? Criterion-referenced tests vs. norm-referenced tests. https://www.renaissance.com/2018/07/11/blog-criterion-referenced-tests-norm-referenced-tests/
Free DIRECT download: PROMs & person-centered care (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by Marcus Aurelius from Pexels.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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