What is a PROM?

A Patient Reported Outcome Measure (PROM) is a questionnaire that asks patients to self report about their own health. PROMs can be used to assess the impact that interventions and treatments may have on a patient’s quality of life.

A PROM is made up of statements or questions known as ‘items’ which are used to find out specific pieces of information about a patient’s health. For example “How much bodily pain have you had during the past 4 weeks?”. These items are scaled or scored to give you a measurement.

There are many PROMs available, which all measure different things (such as well-being or patient satisfaction) and for different purposes (for example clinical decision-making or assessing the impact of interventions). PROMs can also be generic or condition specific. Generic PROMs are intended to be applicable to all clinical areas, whereas condition specific PROMs are only intended to be applicable to a particular clinical area or disease, for example asthma or diabetes.

When we develop a PROM, the first things to be clear about are what the purpose of the PROM is and who it is for.

For example, we may wish to develop a PROM for use in assessing the symptoms experienced by patients with irritable bowel syndrome in order to allow clinicians to monitor how patients are doing over time.

Or, we may wish to develop a generic measure of health related quality of life to help us to assess the impact of interventions and compare across many clinical areas.

Once this has been determined, the next step is to decide what items to include. There are two main approaches to this; bottom-up or top-down methodologies. Traditionally a top-down approach has been used, where items are informed from literature, existing measures, and/or expert opinion. A criticism of this approach is that the content (and coverage) of the items may not be relevant to the target population. One way of addressing this is to use a bottom-up approach. Here patients, interested parties, or members of the public are involved in the development of the measure. This may be to inform what the items are, but can also include how they are phrased so that appropriate language and terminology is used.

We’ll take a closer look at some of the methods for developing a PROM in the next step.