Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities

Patient reported outcomes (PROs) refer to any report of the status of a patient's health condition that comes directly from the patient. While PROs are a well-developed technology with robust standards in research their use for informing health care decisions is generally poorly understood. In this paper we review relevant examples of their application in health care provision to date, and examine the challenges associated with routinely implementing PROs in clinical settings. We evaluate evidence for their use, and examine key barriers, such as where there is a lack of alignment between interpretation of scores and clinical decision making on the ground. Based on available evidence we have developed a framework of the key requirements for the successful implementation of PROs in clinical practice. We conclude by exploring potential future developments for the use of PROs in clinical practice, such as individualised measurement and efficient administration through the use of computer adaptive tests (CATs).