Comparing PRO data from individual patients or groups of patients to reference groups (e.g., benchmark subpopulations or similar patients in a provider’s practice) facilitates patient-provider communication regarding treatment progress, behavioral factors in intervention outcomes (e.g., the effect of smoking status), and the setting of expectations regarding interventions. Comparing a patient’s individual PRO score with aggregate scores from similar patients, may be especially valued in some contexts.
Strategy A
Provide reports that compare individual patient data or patient group data with reference subpopulations to facilitate decision-making and inform patient care
Providing ePRO reports that compare PRO scores (e.g., one patient or group of patients to a reference group of patients) facilitates understanding of patient status for clinical use of PROMs in patient care. ePRO reports can showcase various types of comparisons as illustrated by Figure 4E (i–v).
Comparison groups are matched by specified parameters, such as demographics or treatment type. Appropriate comparison groups for a patient or group of patients are dictated by the purpose of the comparison and the clinical context. Because defining a relevant group for comparison varies depending upon the clinical context, comparative ePRO reporting that offers options to filter data sets to arrive at appropriate comparisons may be most useful.
Quote from Provider Interviews:
“If a patient is complaining of pain in a week or two after surgery and wondering, ‘When is this going to end? How am I going to begin to feel better?’ I think showing them on average other patients who have the same procedure, [who] recover at such and such time interval [would be helpful].”
Figure 4E (i–v): Types of comparisons in ePRO reporting
Figure 4E (i). Line graph comparing one provider’s patients with all other patients in a practice
Figure 4E (ii). Bar graph comparing one patient with all patients for one provider practice and with all patients in the practice group
Figure 4E (iii). Pictograph comparing one group of patients to another group of patients
Figure 4E (iv). Table comparing one patient with all other related patients in a hospital
Figure 4E (v). Scatter graph comparing an individual patient with all other patients in a practice
Table 4C lists factors to consider when designing ePRO comparative reports for provider use.
Table 4C: Strategy considerations for providing PRO comparative data
Appropriate populations for comparison may include:
the general population (seeking general benchmark)
patients within the same practice (particularly for comparing nuances in intervention practices) or
the individual provider’s patient panel (this patient compared with my average patient).
Identification of similar comparison groups (diagnosis, intervention/ treatment, symptoms)
Providers may define similar groups based on parameters including patient diagnosis, intervention/treatment, and/or symptoms).
Importance of including patient characteristics
Characteristics (e.g., demographics, socio-economic status, literacy) of the comparison group may be important in some circumstances, such as when comparing procedure complication rates.
Accepted clinical benchmark exists
When standardized expectations of outcomes exist for PROs, the standard outcome (e.g., blood pressure or A1C target) may be used as a comparator in lieu of or in addition to group comparisons to track patient progress.
Some of the more prevailing challenges regarding the strategy are listed below, along with tactics to consider in addressing these challenges:
Challenges and Tactics Comparative Information
Challenges
Selecting comparison groups: It may be difficult to identify appropriate comparison groups.
Outliers: Outlier date may skew comparison groups.
Appropriate comparisons can vary: Even when common measures are used, the clinical context can mean different comparison groups are needed.
Comparing small populations/groups: Small groups may necessitate greater data security to ensure patient privacy.
Contextual information: Some comparisons may need additional information beyond PRO data for information to be clinically useful.
Tactics
Case mix or otherwise adjust comparison groups to derive appropriate comparison groups.
Provide the ability to select among comparison groups for various situational contexts.
Determine whether the size of comparison groups /patient population will require additional privacy measures.
Consider including sample size, demographics, time of data collection, clinical setting, and benchmark information, to contextualize a comparison group.
For additional insight on how to present comparative data, see Recommended Resources related to:
