Medicine, Nursing and Allied Health Professions

Using Patient Reported Outcome Measures (PROMs) for improving the management of chronic conditions

What are PROMs? 

Patient Reported Outcome Measures (PROMs) are questionnaires completed by patients to rate their own health. PROMs can be used for making sure that patients' needs and priorities are properly taken into account when making decisions about their health care. 

Currently, PROMs are used to measure health gain for patients undergoing specific surgical procedures (for example hip and knee replacements) but there is little evidence for their use in general practice, where they are not routinely used. 

PROMs have the potential to improve the quality of healthcare people receive at their GP surgery, and promote a more patient-orientated service. For patients with multiple conditions, they could help prioritise their health issues, align the views of patients and professionals. However, research is needed to test the feasibility of this. 

We conduct applied and translational research into the uses of PROMs. Translational research aims at increasing the scale and speed of progress from scientific discovery to clinical benefit (from a market perspective, turning early-stage innovations into new health products), and our research in PROMs specifically aims at bridging the gap between our developments in methods for the measurement of patient reported outcomes and patient centred safety assessments and its routine implementation in clinical practice.  Our research on the development of a classification system for PROMs, a new tool for assessing the quality of these instruments (EMPRO), and our contribution to the development of on-line PROMs libraries are all aimed at facilitating the uptake of PROMs in clinical practice.

Recent and ongoing collaborations in this area include the OECD PaRIS Initiative and the International Consortium for Health Outcomes Measurement (ICHOM).

Intra-individual cyclical variation of patient reported outcome measures in patients with chronic health conditions. University of Exeter. PI Prof. Jose M Valderas

Routine provision of information on Patient Reported Outcome Measures (PROMs) to healthcare providers and patients in clinical practice: a Cochrane systematic review of the literature. University of Exeter. PI Prof. Jose M Valderas.

Meta-synthesis of perceptions of patients and health professionals on the use of Patient Reported Outcome Measures (PROMs) in clinical practice. University of Exeter. PI Prof. Jose M Valderas.

Development of an individualisation module for the Evaluation of the Measurement Properties of Patient Reported Outcomes (EMPRO) tool. University of Exeter. PI Dr. Ian Porter

Patient Reported Indicator Survey (PaRIS): international survey on outcomes and experiences of patients with chronic conditions. Organisation for Economic Co-operation and Development (OECD) 15/01/2019-14/10/2023. Role: Co-applicant (PI: Dr. Dolf Boer, Netherlands Institute for Health Services Research (NIVEL), Netherlands).

OECDs Patient-Reported Indicator Survey (PaRIS): development work in Norway as basis for an application to Horizon Europe on comparative health system analysis and research. Norwegian Institute for Public Health, 1/6/20-30/5/21. Role: Co-applicant (PI: Øyvind Andresen Bjertnæs, Norwegian Institute for Public Health, Norway).

Use of PROMs in general practice in the management of individuals with multimorbidity. University of Exeter. PI Prof. Jose M Valderas 

Overall Adult Health Outcomes Standard Set. International Consortium for Health Outcomes Measurement (ICHOM). Chair of panel: Jose M Valderas. 

Development and validation of the English version of the short form of the Arterial Hypertension Quality of Life Questionnaire (Mini-CHAL). The Gawthorn Cardiac Trust. Andrew Jordan.

Using Patient Reported Outcome Measures (PROMs) for optimising interventional treatment of lateral epicondylar tendonopathy. British Elbow and Shoulder Society (BESS) and Royal Devon and Exeter Hospital - Small Grants award. 01/03/2016-28/02/2018. PIs Prof. Jose M Valderas and Mr Jonathan Evans

Risk-benefit and costs of unicompartmental (compared to total) knee replacement for patients with multiple co-morbidities: a non-randomised study and different novel approaches to minimise confounding. NIHR HTA. 1/2/2017 (24 months) PI Dr Daniel Prieto-Alhambra, University of Oxford, UK

Cross-national invariance in the measurement of general self-reported health using the short form PROMIS-29 across nationally representative samples in Germany, France, and the UK. Centre Virchow-Villerme. Co-PI: Prof Dr Matthias Rose, La Charite University of Berlin and Prof Alain Leplege, France. 1/1/2015-31/12/2016

Metrics of Person Centred Care Metrics for LTCs, MLTc and for those at the end of their life. NHS England. PI Dr Helen Lloyd, University of Plymouth, UK. 01/2/2016-31/08/2016

Development of two short versions of the Patient Reported Experiences and Outcomes of Patient Safety (PREOS-PC). University of Nottingham. PI Prof. Jose M Valderas. 15/04/2016-15/09/2016.

The use of Patient Reported Outcome Measures (PROMs) in improving primary care for people with multi-morbidity. Clinician Scientist Award. National Institute for Health Research, Department of Health, UK. PI Prof. Jose M Valderas. 01/3/2011-29/2/2016

Functionality and feedback: A realist synthesis of the collation, interpretation, and utilisation of PROMs data to improve patient care. NIHR Service Delivery and Organisation Programme.PI: Dr Joanne Greenhalgh, University of Leeds, UK. 1/1/2014-1/7/2015

Validating patient-reported outcome measures (PROMs) in chronic kidney disease (CKD) patients in primary care settings. NIHR School for Primary Care Research. PI: Dr Yaling Yen, University of Oxford, UK. 1/11/2013-31/7/2015

Information and value-based commissioning. NIHR SDO Programme. PI Prof Barry McCormick, University of Oxford, UK. 2012-2014.

Developing, testing and implementing the NSPCR Patient Safety Toolkit in general practices in England. NIHR School for Primary Care Research. PI Prof. Tony Avery, University of Nottingham, UK. 01/10/2011-31/12/2013

Evans JP, Porter I, Gangannagaripalli JB, Bramwell C, Davey A, Smith CD, Fine N, Goodwin VA, Valderas JM. Assessing patient-centred outcomes in lateral elbow tendinopathy: A systematic review and standardised comparison of English language clinical rating systems. Sports Med Open. 2019;5(1):10. doi: 10.1186/s40798-019-0183-2. PubMed

Hjollund NH, Valderas JM,Kyte D, Calvert MJ. Health data processes. A framework for analysing and discussing efficient use and reuse of health data with focus on Patient Reported Outcome (PRO) measures. J Med Internet Res 2019 May 21;21(5):e12412. doi: 10.2196/1241.  PubMed

Calvert M, Kyte D, Valderas JM, Hollund NH. Maximising the impact of patient-reported outcome assessment for patients and society: why we need a more integrated approach. BMJ 2019;364:k5267. PubMed

Arias-de la Torre J, Puigdomenech E, Valderas JM, Evans JP, Martin V, Molina AJ, Rodriguez N, Espallargues M. Availability of specific tools to assess Patient Reported Outcomes in hip arthroplasty in Spain. Identifying the best candidates to incorporate in an arthroplasty register. A systematic review and standardized assessment. PLOS One 2019  Apr 1;14(4):e0214746. doi: 10.1371/journal.pone.0214746. PubMed

Arias de la Torre J, Pons-Cabrafiga M, Valderas JM, Evans JP, Martin V, Molina AJ, Pallisó F, Smith K, Martinez O, Espallargues M. Influence of hospital volume of procedures by year on the risk of revision of total hip and knee arthroplasties. A Propensity Score-Matched Cohort Study. J Clin Med 2019;8:670 doi:10.3390/jcm8050670 PubMed

Evans J, Smith C, Gangannagaripalli J, Porter I, Goodwin V, Valderas JM. Patient-centred outcomes in lateral elbow tendinopathy: a systematic review of available evidence in UK populations. Shoulder Elbow 2018 doi:10.1177/1758573218791164 PubMed

Evans JP, Smith CD, Fine NF, Porter I, Gangannagaripalli J, Goodwin VA, Valderas JM. Clinical rating systems in elbow research — a systematic review exploring trends and distributions of use. J Shoulder Elbow Surg 2018;27(4):e98-e106. doi:10.1016/j.jse.2017.12.027 PubMed

Evans JP, Smith A, Gibbons C, Alonso J, Valderas JM. The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS): a view from the UK. J Pat Reported Outcom 2018;9:345-352. doi: 10.2147/PROM.S141378 PubMed

Wheat H, Horrell J, Valderas JM, Close J, Fosh B, Lloyd H. Can practitioners use patient reported measures to enhance person centred coordinated care in practice? A qualitative study. Health Qual Life Outcomes 2018;16(1):223. doi: 10.1186/s12955-018-1045-1 PubMed

Coste J, Rouquette A, Valderas JM, Rose M, Leplège A. The French PROMIS-29. Psychometric validation and population reference values. Rev Epidemiol Sante Publique 2018 Sep;66(5):317-324. doi: 10.1016/j.respe.2018.05.563. Epub 2018 Jul 25. PubMed

Fischer F, Gibbons C, Coste J, Valderas JM, Rose M, Leplège A. Measurement invariance and general population reference values of the PROMIS Profile 29 in the UK, France, and Germany. Qual Life Res. Q2018;27(4):999-1014. PubMed

Lloyd H, Wheat H, Horrell J, Sugavanam P, Fosh B, Valderas JM, Close J. Patient reported measures for person-centred coordinated care: a comparative domain map and online compendium for supporting policy development and implementation. J Med Internet Res 2018;20(2):e54. doi: 10.2196/jmir.7789 PubMed

Greenhalgh J, Dalkin S, Gibbons E, Wright J, Valderas JM, Meads D, Black N. How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis. J Health Serv Res Policy. 2018 Jan;23(1):57-65. doi: 10.1177/1355819617740925 PubMed

Greenhalgh J, Gooding K, Gibbons E, Dalkin SM, Wright J, Valderas JM, Black N. How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis. J Pat Reported Outcomes 2018;2:42. PubMed

Lloyd HM, Pearson M, Sheaff R, Asthana S, Wheat H, Sugavanam TP, Britten N, Valderas J, Bainbridge M, Witts L, Westlake D, Horrell J, Byng R. Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care. Health Res Policy Syst. 2017;15(1):98. doi: 10.1186/s12961-017-0263-z PubMed

Greenhalgh J, Dalkin S, Gooding K, Gibbons E, Wright J, Meads D, Black N, Valderas JM, Pawson R. Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care. Health Serv Deliv Res 2017;5(2). doi: 10.3310/hsdr05020 PubMed

Porter I, Goncalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, Black N, Greenhalgh J, Valderas JM. Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities. J Comp Eff Res. 2016;5(5)507-19. doi: 10.2217/cer-2015-0014. PubMed

Gibbons C, Bower P, Lovell K, Valderas J. Skevington SElectronic Quality of Life Assessment using computer-adaptive testing. J Med Internet Res 2016;18(9):e240. doi: 10.2196/jmir.6053. PubMed

Black N, Burke L. Forrest CB, Ravens Sieberer UH, Ahmed S, Valderas JM, Bartlett SJ, Alonso J. Patient-Reported Outcomes: pathways to better health, better services and better societies. Qual Life Res 2015;25(5):1103-12 doi:10.1007/s11136=015-1168-3 PubMed

Ricci-Cabello I, Gonçalves DC, Rojas-García A, Valderas JM. Measuring experiences and outcomes of patient safety in primary care: a systematic review of available instruments. Fam Pract. 2015 Feb;32(1):106-19. doi: 10.1093/fampra/cmu052. Epub 2014 Sep 5. PubMed

Schmidt S, Ferrer M, González M, González N, Valderas JM, Alonso J, Escobar A, Vrotsou K; EMPRO Group. Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence. J Shoulder Elbow Surg. 2014 Mar;23(3):434-44. doi: 10.1016/j.jse.2013.09.029. PubMed

Schmidt S, Garin O, Pardo Y, Valderas JM, Alonso J, Rebollo P, Rajmil L, Garcia-Forero C, Ferrer M, the EMPRO Group. Assessing quality of life in patients with prostate cancer: a systematic and standardized comparison of available instruments. Qual Life Res. 2014; 23(8):2169-81. doi: 10.1016/j.jse.2013.09.029. PubMed

Garin O, Herdman M, Vilagut G, Ferrer M, Ribera A, Rajmil L, Valderas JM, Guillemin F, Revicki D, Alonso J. Assessing health-related quality of life in patients with heart failure: a systematic, standardized comparison of available measures. Heart Fail Rev. 2014 May;19(3):359-67. doi: 10.1007/s10741-013-9394-7. PubMed

Mavaddat N, Valderas JM, van der Linde R, Khaw KT, Kinmonth AL. Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study. BMC Fam Pract. 2014 Nov 25;15:185. doi: 10.1186/s12875-014-0185-6. PubMed

Greenhalgh J, Pawson R, Wright J, Black N, Valderas JM, Meads D, Gibbons E, Wood L, Wood C, Mills C, Dalkin S. Functionality and feedback: a protocol for a realist synthesis of the collation, interpretation and utilisation of PROMs data to improve patient care. BMJ Open. 2014 Jul 22;4(7):e005601. doi: 10.1136/bmjopen-2014-005601. PubMed

Alonso J, Bartlett SJ, Rose M, Aaronson NK, Chaplin JE, Efficace F, Leplège A, Lu A, Tulsky DS, Raat H, Ravens-Sieberer U, Revicki D, Terwee CB, Valderas JM, Cella D, Forrest CB, PROMIS International Group. The case for an international patient-reported outcomes measurement information system (PROMIS®) initiative. Health Qual Life Outcomes. 2013 Dec 20;11:210. doi: 10.1186/1477-7525-11-210. PubMed

Valderas JM. Getting impatient about person-centred health care. Eur J Gen Pract. 2013 Sep;19(3):141-2. doi: 10.3109/13814788.2013.823601. PubMed

Palacio-Vieira JA, Villalonga-Olives E, Valderasa JM, Herdman M, Alonso J, Rajmil L. Predictors of the use of healthcare services in children and adolescents in Spain. Int J Pub Health. 2013;58(2):207-15 doi: 10.1007/s00038-012-0360-2 PubMed 

Violán C, Foguet-Boreu Q, Hermosilla-Pérez E, Valderas JM, Bolíbar B, Fàbregas-Escurriola M, Brugulat-Guiteras P, Muñoz-Pérez MÁ. Comparison of the information provided by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity. BMC Public Health. 2013 Mar 21;13:251. doi: 10.1186/1471-2458-13-251. PubMed

Villalonga-Olives E, Forero CG, Maydeu-Olivares A, Almansa J, Palacio Vieira JA, Valderas JM, Ferrer M, Rajmil L, Alonso J. Environmental risk and protective factors of adolescents' and youths' mental health: differences between parents' appraisal and self-reports. Qual Life Res. 2013 Apr;22(3):613-22. doi: 10.1007/s11136-012-0167-x. Epub 2012 Apr 7. PubMed

Valderas JM, Fitzpatrick R, Roland M. Using health status to measure NHS performance: another step into the dark for the health reform in England. BMJ Qual Saf. 2012 Apr;21(4):352-3. doi: 10.1136/bmjqs-2011-000184. PubMed

Almansa J, Ayuso-Mateos JL, Garin O, Chatterji S, Kostanjsek N, Alonso J, Valderas JM, Cieza A, Raggi A, Svestkova O, Burger H, Racca V, Vieta E, Leonardi M, Ferrer M, MHADIE Consortium. The International Classification of Functioning, Disability and Health: development of capacity and performance scales. J Clin Epidemiol. 2011 Dec;64(12):1400-11. doi: 10.1016/j.jclinepi.2011.03.005. Epub 2011 Jun 12. PubMed

Villalonga-Olives E, Forero CG, Erhart M, Palacio-Vieira JA, Valderas JM, Herdman M, Ferrer M, Rajmil L, Ravens-Sieberer U, Alonso J.  Relationship between life events and psychosomatic complaints during adolescence/youth: a structural equation model approach. J Adolesc Health. 2011 Aug;49(2):199-205. doi: 10.1016/j.jadohealth.2010.11.260. Epub 2011 Feb 11. PubMed

Garin O, Ayuso-Mateos JL, Almansa J, Nieto M, Chatterji S, Vilagut G, Alonso J, Cieza A, Svetskova O, Burger H, Racca V, Francescutti C, Vieta E, Kostanjsek N, Raggi A, Leonardi M, Ferrer M; MHADIE consortium. Validation of the "World Health Organization Disability Assessment Schedule, WHODAS-2" in patients with chronic diseases. Health Qual Life Outcomes. 2010 May 19;8:51. doi: 10.1186/1477-7525-8-51. PubMed

Villalonga-Olives E, Rojas-Farreras S, Vilagut G, Palacio-Vieira JA, Valderas JM, Herdman M, Ferrer M, Rajmil L, Alonso J. Impact of recent life events on the health related quality of life of adolescents and youths: the role of gender and life events typologies in a follow-up study. Health Qual Life Outcomes. 2010 Jul 19;8:71. doi: 10.1186/1477-7525-8-71. PubMed

Rajmil L, Palacio-Vieira JA, Herdman M, López-Aguilà S, Villalonga-Olives E, Valderas JM, Espallargues M, Alonso J. Effect on health-related quality of life of changes in mental health in children and adolescents. Health Qual Life Outcomes. 2009 Dec 23;7:103. doi: 10.1186/1477-7525-7-103. PubMed

Valderas JM, Alonso J. Patient reported outcome measures: a model-based classification system for research and clinical practice. Qual Life Res. 2008 Nov;17(9):1125-35. doi: 10.1007/s11136-008-9396-4. PubMed

Valderas JM, Ferrer M, Mendívil J, Garin O, Rajmil L, Herdman M, Alonso J, Scientific Committee on "Patient-Reported Outcomes" of the IRYSS Network. Development of EMPRO: a tool for the standardized assessment of patient-reported outcome measures. Value Health. 2008 Jul-Aug;11(4):700-8. doi: 10.1111/j.1524-4733.2007.00309.x. Epub 2008 Jan 8. PubMed

Valderas JM, Alonso J, Guyatt GH. Measuring patient-reported outcomes: moving from clinical trials into clinical practice. Med J Aust. 2008 Jul 21;189(2):93-4. PubMed

Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, Revicki DA, Symonds T, Parada A, Alonso J. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res. 2008 Mar;17(2):179-93. doi: 10.1007/s11136-007-9295-0. PubMed

Valderas JM. Measurement of health and disabilityLancet 2007 Aug 11;370(9586):483-4; author reply 484. doi: 10.1016/S0140-6736(07)61229-X. PubMed

Valderas JM, Rue M, Guyatt G, Alonso J; Systematic Use of Quality of Life Measures in the Clinical Practice Working Group. The impact of the VF-14 index, a perceived visual function measure, in the routine management of cataract patients. Qual Life Res. 2005 Sep;14(7):1743-53. doi: 10.1007/s11136-005-1745-y. PubMed

Valderas JM, Alonso J, Prieto L, Espallargues M, Castells X. Content-based interpretation aids for health-related quality of life measures in clinical practice. An example for the visual function index (VF-14). Qual Life Res. 2004 Feb;13(1):35-44. doi: 10.1023/B:QURE.0000015298.09085.b0. PubMed 

Espallargues M, Valderas JM, Alonso J. Provision of feedback on perceived health status to health care professionals: a systematic review of its impact. Med Care. 2000 Feb;38(2):175-86. doi: 10.1097/00005650-200002000-00007. PubMed