Assessing Whole-Person Outcomes During Routine Clinical Care

Abstract

Objective:

To identify and describe research conducted on the implementation, validity, and utility of whole-person outcome measures administered during routine inpatient or outpatient care.

Background:

Incorporating information about patients’ overall health, health-related quality of life, and global well-being into health care delivery has the potential to increase referral rates, enhance doctor-patient communication, and improve the detection of untreated symptoms. Assessment of these whole-person outcomes during routine clinical care is of broad interest to health care providers and health systems.

Methods:

We employed a scoping review design and searched Ovid MEDLINE, APA PsycINFO, and CINAHL for relevant English-language primary studies and systematic reviews published through November 13, 2023. Screening for inclusion and data abstraction were conducted by 1 investigator then checked by another. Study risks of bias and the strength of available evidence were not assessed.

Results:

Of 1327 potentially relevant publications, 44 primary studies and 5 systematic reviews met eligibility criteria. Assessment of global well-being was comparatively less researched than overall health or health-related quality of life. Available research provided a range of perspectives on the performance, feasibility, acceptability, implementation, and clinical utility of whole-person outcome measures. No studies reported change in patient health or disease outcomes attributed to whole person outcome assessment (directly or through changes to care delivery).

Conclusions:

Currently available evidence provides insights about the performance and implementation of whole-person outcome measures during routine clinical care, but no studies are available that examine the impact of assessing whole-person outcomes on clinical or patient outcomes.

Patient-reported outcomes (PROs) encompass a broad array of clinically relevant outcomes described by, and considered meaningful to, health care patients.¹ Many available PRO measures assess condition-specific symptom burden (eg, Parkinson's disease symptom severity and impact on functionality), but measures are also available to assess general states such as health-related quality of life, global well-being, and overall health. These general states are sometimes referred to as “whole-person outcomes” because they provide information about aspects of a person’s health beyond the immediately presenting condition or symptoms, including emotional and social dimensions of health. Whole-person outcome measures have been developed for patients with specific conditions or receiving certain treatments (eg, overall quality of life of patients with Parkinson's disease) or for broad use across clinical or research settings.^1,2 The latter can be referred to as general or generic measures.

Provider awareness of results from whole person outcome measures—and subsequent review and discussion of results with patients during routine clinical care—has the potential to increase the likelihood of referrals and lead to better tailored care.^3,4 Greater patient-provider communication might also increase patient satisfaction with care and result in the detection of previously untreated symptoms.^5–7 Consequently, results of measures that are informative about patients’ general state may be useful as quality of care metrics.^6,8 In the context of health systems that provide nonclinical health services (eg, housing supports or social reintegration programs), it is also possible that general PRO measures could be more sensitive to the impact of these services compared with measures of disease symptoms alone. For these reasons, assessing patients' overall health, health-related quality of life, and global well-being is increasingly of interest to health care providers and health systems alike.⁹

To date, most whole person outcome assessment has occurred in clinical trials and other treatment or intervention studies, where whole person outcomes are assessed alongside symptom-specific PROs and objective measures of treatment effectiveness (eg, overall survival).^4,10 Over the last 2 decades, however, interest in assessing whole-person outcomes during routine inpatient and outpatient clinical care has increased.^4,8 Research on this topic has focused on (1) developing measures that can be feasibly administered during clinical care (ie, have minimal patient and provider burden), (2) integrating measures into clinical data collection systems, and (3) establishing clinical pathways that enable results to be delivered to providers efficiently and that assist providers in identifying and carrying out appropriate follow-up steps (eg, referrals to other services).^4,6,11,12 The purpose of this scoping review was to identify and describe research conducted in these areas.

METHODS

The present review was originally intended to inform research and policy-making activities within the U.S. Department of Veterans Affairs, and as a result, a protocol for the review was not prospectively registered. Reporting of the review adhered to preferred reporting items for systematic reviews and meta-analyses guidance whenever feasible. Given the use of published aggregate data, ethics approval or oversight was not required.

Eligibility Criteria

Eligible studies must have been conducted among adults during routine inpatient or outpatient clinical care. Studies were required to describe the assessment of the patient-reported status of, or satisfaction with, overall health (ie, general physical or mental health), health-related quality of life (ie, the extent to which patient health impacts overall functionality and engagement with usual activities), or global well-being (ie, well-being across multiple domains or aspects of a patient’s life). Studies that met these criteria were required to report on the implementation of whole-person outcome measures (eg, feasibility, barriers/facilitators, strategies to overcome feasibility limitations or implementation barriers, provider satisfaction, patient satisfaction), the extent to which measure results altered care delivery and/or patient outcomes, or on measure performance (eg, validity, reliability, etc).

Studies that examined measures of disease or condition symptoms or that were conducted in emergent care settings were ineligible. In addition, studies whose main aim was to assess the effectiveness of an intervention or treatment—and simply included whole-person outcome measures among other patient-reported and objective measures of effectiveness—were not considered. The rationale for this focus was that such studies would be unlikely to provide detail about implementation of measures of interest, and would often be highly controlled and not reflect real-world clinical practice conditions. Moreover, while clinical trials and other effectiveness studies could provide evidence about a treatment’s impact on both a symptom and whole-person outcomes, such studies were not expected to provide information about (1) how routine measurement of whole-person outcomes influenced clinical practice and (2) how any changes to clinical practice altered patient or disease outcomes.

Data Sources and Searches

A research librarian searched Ovid MEDLINE, APA PsycINFO, and CINAHL for relevant English-language primary studies and systematic reviews published through November 13, 2023 (see Supplemental Materials for complete search strategies, Supplemental Digital Content 1, http://links.lww.com/MLR/C875). Search strategies were reviewed by the first author before searching. Titles, abstracts, and full-text articles were reviewed by 1 investigator then checked by another. Any disagreements about inclusion were resolved by consensus. Studies excluded during full-text screening and reasons for exclusion are provided in the Supplemental Materials (Supplemental Digital Content 1, http://links.lww.com/MLR/C875).

Data Abstraction and Organization

All data abstraction was first completed by 1 reviewer then checked by another. We used a standardized tool to abstract data on participant characteristics, study design, health care context, whole-person outcome measures, and measurement setting and modality. For systematic reviews, we abstracted search dates, number of included studies, population and health care setting characteristics, risk of bias assessment tool used, and included measures and outcomes. As a scoping review, we did not formally assess study risk of bias or evaluate the strength of available evidence.

Identified studies and measures were organized first by measure domain (overall health, health-related quality of life, or global well-being), then by health care context or setting (eg, cancer/oncology, outpatient psychiatry, general clinical practice).

RESULTS

Literature Flow

The literature flow diagram (Fig. 1) summarizes the results of the study selection process (references of excluded studies with reasons for exclusion are provided in the Supplemental Materials, Supplemental Digital Content 1, http://links.lww.com/MLR/C875). Common reasons for exclusion were: (1) the PRO measure used in a study assessed condition-specific symptom burden and not a general state of health, quality of life, or well-being; (2) a study examined the use of any PRO measure in clinical practice and did not disaggregate results by the outcome or construct assessed by individual measures; or (3) the publication was an expert position paper or nonsystematic overview of evidence on whole-person outcome assessment in clinical settings.

FIGURE 1.

Literature flow diagram. CDSR indicates Cochrane Database of Systematic Reviews; CINAHL, Cumulative Index to Nursing and Allied Health Literature.

Literature Overview

Our search identified 166 potentially relevant articles after deduplication and title and abstract screening. Of these, 5 systematic reviews^13–17 and 44 primary studies met all eligibility criteria. Among primary studies, 2 were randomized controlled trials,^18,19 14 were prospective or retrospective cohorts,^20–33 8 were cross-sectional survey studies,^34–42 15 were qualitative or mixed-methods studies,^43–57 and 4 were descriptive studies of implementation experiences.^58–61 The median sample size of studies was 150 but ranged widely (15–206,685). Studies varied in whether they enrolled patients, providers, or a mixture of both.

The majority of studies were carried out in outpatient/ambulatory health care settings; 11 studies^{22,23,26,30–32,36,45,46,53,55} were conducted in inpatient or surgical settings, and 3 studies^35,60,61 included multiple or general clinical settings. Studies reported a range of outcomes; however, no primary study was identified that reported change in health outcomes attributed to whole-person outcome assessment (directly or through changes to care delivery). Additional characteristics of primary studies, including specific measures employed and outcomes assessed, are presented in Table 1. Included systematic reviews are discussed later.

TABLE 1.

Measures and Outcomes of Included Primary Studies

Measure	Validity and/or responsiveness	Feasibility	Acceptability	Barriers/facilitators	Clinical utility
General/multiple health care settings
Overall health
HUI	—	Santana, 201560	—	Santana, 201560	Santana, 201560
PROMIS-GH/10	Lapin, 202342 Blumenthal, 201721	Harrison, 202253	—	Harrison, 202253	Lapin, 202342 Harrison, 202253
SF-12/36	Garratt, 199438	—	Garratt, 199438	Philpot, 201849	Philpot, 201849
TOPICS-MDS	—	—	Pel-Littel, 201948		Pel-Littel, 201948
Any generic PROM	—	—	—	Joeris, 201846	Joeris, 201846
Health-related quality of life
EQ-5D	Snowdon, 202355	Snowdon, 202355 Porter, 202150	Snowdon, 202355 Kelly, 202147 Porter, 202150	Snowdon, 202355 Kelly, 202147 Porter, 202150	Snowdon, 202355 Kelly, 202147 Porter, 202150
HUI	—	Santana, 201560	—	Santana 201560	Santana 201560
Ad hoc	—	Zahrieh, 201961	Zahrieh, 201961	—	Zahrieh, 201961
Global well-being
TOPICS-MDS	—	—	Pel-Littel, 201948	—	Pel-Littel, 201948
Any generic PROM	—	—	—	Joeris, 201846	Joeris, 201846
Cancer/oncology
Overall health
PROMIS-GH/10	Stover, 201551	Brunelli, 202235 Rotenstein, 201759 Stover, 201551	Brunelli, 202235 Rotenstein, 201759 Stover, 201551	Brunelli, 202235 Rotenstein, 201759	Rotenstein, 201759 Stover, 201551
SF-12/36	O’Neill, 202354	O’Neill, 202354 Brunelli, 202235	O’Neill, 202354 Brunelli, 202235	O’Neill, 202354 Brunelli, 202235	—
Health-related quality of life
EQ-5D	Schuler, 201726	Brunelli, 202235 Sztankay, 201929	Brunelli, 202235 Crockett, 202236 Schuler, 201726 Sztankay, 201929	Brunelli, 202235 Crockett, 202236	Crockett, 202236 Sztankay, 201929
Any generic PROM	—	Graupner, 202145	—	Graupner, 202145	Graupner, 202145
Diabetes
Overall health
RAND-12	—	Hernar, 201939	Hernar, 201939	Hernar, 201939	—
Global well-being
WHO-5	—	Hernar, 202118 Hernar, 201939	Hernar, 202118 Hernar, 201939	Hernar, 202118 Hernar, 201939	Hernar, 202118
Genetic counseling
Health-related quality of life
EQ-5D	Costal Tirado, 201744	Costal Tirado, 201744	Costal Tirado, 201744	Costal Tirado, 201744	Costal Tirado, 201744
Mental health/substance misuse
Overall health
PROMIS-GH/10	Yi, 202333	Yi, 202130	—	—	Yi, 202333
SF-12/36	Adler, 200020	Kristensen, 201858 Adler, 200020	Kristensen, 201858 Adler, 200020	Kristensen, 201858 Adler, 200020	—
Health-related quality of life
EQ-5D	—	van Sonsbeek, 202357	—	van Sonsbeek, 202357	—
WHO-DAS	Sexton, 201941	Kristensen, 201858	Kristensen, 201858	Kristensen, 201858	—
Global well-being
SWLS/SHS	Aunjitsakul, 202134	—	—	—	—
14-SGWB	Holland, 202124	—	—	Holland, 202124	—
WHO-5	—	Kristensen, 201858	Kristensen, 201858	Kristensen, 201858	—
SWEMWBS	Shah, 202127 Shah, 201828	—	—	—	—
Nephrology/kidney care
Overall health
SF-12/36	van der Willik, 202356	van der Willik, 202356	van der Willik, 202356	van der Willik, 202356	van der Willik, 202356
Neurology and cerebrovascular disease
Overall health
PROMIS-GH/10	Glimmerveen, 202331	—	Glimmerveen, 202331	—	Glimmerveen, 202331
SF-12/36	Wagner, 199719	—	Wagner, 199719	—	Wagner, 199719
Health-related quality of life
EQ-5D	Katzan, 201725	Recinos, 201740	Recinos, 201740	—	Recinos, 201740
Rare diseases
Overall health
SF-12/36	—	—	Aiyegbusi, 202043	Aiyegbusi, 202043	—
Health-related quality of life
EQ-5D	—	—	Aiyegbusi, 202043	Aiyegbusi, 202043	—
Rheumatology and orthopedics
Overall health
PROMIS-GH/10	Darrith, 202122	—	—	—	—
Health-related quality of life
EQ-5D	—	Tai, 202052	Tai, 202052	Tai, 202052	Tai, 202052
BRFSS-HRQOL	Currey, 200337	—	—	—	—
Global well-being
PWI	Sinnott, 202332	—	—	—	Sinnott, 202332
Septorhinoplasty
Health-related quality of life
EQ-5D	Fuller, 201723	—	—	—	—

BRFSS-HRQOL indicates Behavioral Risk Factor Surveillance System Health-Related Quality of Life; HUI, Health Utilities Index; PROM, patient-reported outcome measure; PROMIS-GH/10, Patient Reported Outcomes Measurement Information System–Global Health or 10-item; PWI, Personal Well-being Index; RAND-12, RAND-12 Health Status Inventory; SF-12/36, Short Form Health Survey 12 or 36-item; 14-SGWB, 14-item Scale of General Well-Being; SHS, Subjective Happiness Scale; SWEMWBS, Short Warwick-Edinburgh Mental–Well-Being Scale; SWLS, Satisfaction with Life Scale; TOPICS-MDS, Older Persons and Informal Caregivers Survey Minimum DataSet; WHO-5, 5-item World Health Organization Well-being Index; WHO-DAS, World Health Organization Disability Assessment Schedule.

Overall Health

The Patient Reported Outcomes Measurement Information System–Global Health or 10-item (PROMIS-GH/10) scales and the Short Form Health Survey 12 or 36-item (SF-12/36) were the most commonly used overall health measures. The PROMIS-GH/10 was often employed in cancer care/oncology settings. Three studies^35,51,59 in this area reported implementation characteristics of the measure; of these, 2 studies^51,59 also described the measure’s clinical utility and 1 study⁵¹ reported scale validity. Three studies^21,42,53 employed the PROMIS-GH/10 in general health settings or across multiple health care domains. These studies reported on the validity and/or responsiveness of the measure (2 studies^21,42), its clinical utility (2 studies^42,53), and implementation characteristics (1 study⁵³). Additional studies of the PROMIS-GH/10 investigated feasibility among patients treated for stroke³¹ or in residential treatment for alcohol/substance use disorder;³⁰ validity and responsiveness among stroke,³¹ alcohol/substance use disorder,³³ or orthopedic surgery patients;²² and clinical utility in substance use treatment³³ and stroke care.³¹ One identified systematic review¹⁵ included the PROMIS-GH and SF-36 and described evidence on the feasibility of implementing overall health assessment in clinics serving adults with epilepsy.

Implementation characteristics of the SF-12/36 were examined in cancer care settings,^35,54 an outpatient psychiatry setting,²⁰ a psychiatric clinical registry,⁵⁸ an epilepsy clinic,¹⁹ a rare disease treatment setting,⁴³ dialysis centers,⁵⁶ and in general clinical practice (2 studies^38,49). One study in general clinical practice,⁴⁹ 1 in nephrology/kidney care,⁵⁶ and 1 in epilepsy care¹⁹ also described the influence of assessment on care. Studies in general practice,³⁸ cancer care,⁵⁴ nephrology/kidney care,⁵⁶ and outpatient psychiatry²⁰ reported scale validity/reliability. Other identified measures of overall health include a 51-item measure developed for the older persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS; 1 study⁴⁸ describing the measure’s acceptability and perceived influence on care among Dutch adults over age 50), the 15-item Health Utilities Index (HUI; 1 study⁶⁰ that developed physician trainings for PRO measurement and assessed implementation characteristics and influence on care across multiple settings), and the 12-item RAND-12 Health Status Inventory (1 study³⁹ assessing the implementation of the measure in a Norwegian outpatient diabetes clinic). The abovementioned systematic review¹⁵ on epilepsy care included the HUI and the Nottingham Health Profile, a 38-item measure of 6 health domains commonly used in Europe.⁶²

Health-Related Quality of Life

The most common measure used to assess health-related quality of life was the 16 or 26-item EQ-5D instrument. These studies described feasibility/acceptability, implementation barriers or facilitators, and the influence of assessment on care in multiple or general health care settings (3 studies^47,50,55), cancer care/oncology (4 studies^26,29,35,36), genetic counseling (1 study⁴⁴), falls prevention (1 study⁵²), outpatient neurology (1 study⁴⁰), mental health care (1 study⁵⁷), and rare diseases (1 study⁴³). Scale validity and/or responsiveness was reported by 1 general health study,⁵⁵ 1 study in stroke patients,²⁵ and another among patients receiving septorhinoplasty.²³ Five systematic reviews included studies that used the EQ-5D: 3^14,16,17 focused on implementation characteristics in routine cancer care, 1¹³ on clinician and patient perspectives on PRO assessments as measures of clinician performance during surgery, and 1¹⁵ on the feasibility of implementing health-related quality of life assessment in a clinic serving adults with epilepsy.

Two additional studies used the World Health Organization Disability Assessment Schedule and described implementation characteristics of the scale in psychiatric clinical registries⁵⁸ and the validity and psychometric properties of the scale among military veterans attending a generalist mental health clinic.⁴¹ Studies also used the 4-item Behavioral Risk Factor Surveillance System Health-Related Quality of Life Measure (1 study³⁷ examining the validity/reliability of the scale in patients with rheumatic disease), the HUI (1 study⁶⁰ developing physician training for PRO measurement and assessing implementation characteristics across multiple settings), and an ad hoc computer-adaptive measure in multiple settings (1 study⁶¹ reporting implementation characteristics and influence on care). The abovementioned systematic review¹⁵ on epilepsy care also included the Sickness Impact Profile, a 136-item scale assessing psychosocial, physical, and other domains of functioning and impairment.⁶² Finally, studies that use the SF-12/36 (described in the previous section) may also provide information about health-related quality of life assessment, given that the measure includes several items that assess the impact of functioning on patient quality of life.

Global Well-Being

The most frequently used global well-being measure was the 5-item WHO Well-being Index (WHO-5), which was used in 2 studies^18,39 of diabetes care and 1 study⁵⁸ of psychiatric clinical registries. All studies using the WHO-5 reported on feasibility, acceptability, and implementation barriers/facilitators; 1 study¹⁸ in diabetes care also discussed the influence of assessment on care. Two identified studies focused on responsiveness^27,28 and construct validity²⁷ of the 7-item Short Warwick‑Edinburgh Mental–Well‑Being Scale during the treatment of common mental disorders. Another study³² examined clinically significant changes in Personal Well-being Index scores after upper extremity reconstructive surgery among patients with tetraplegia.

An additional study²⁴ described the adaptation of the 14-item Scale of General Well-being for use as a clinical outcome measure. The authors reported the results of 2 substudies: the first assessed the psychometric properties and validity of the adapted measure in a nonclinical sample (Table 1 does not reflect these findings due to the ineligible population), and the second evaluated the scale’s responsiveness among patients receiving person-centered therapy. Another study³⁴ reported on the validity and performance of the 5-item Satisfaction with Life Scale, the 4-item Subjective Happiness Scale, and condition-specific measures among people with schizophrenia. The final specific measure studied was the Older Persons and Informal Caregivers Survey Minimum DataSet, which was examined in a qualitative study⁴⁸ describing the acceptability of the measure and its perceived influence on care among Dutch older adults.

DISCUSSION

Studies included in the present review investigated routine clinical assessment with whole-person outcome measures of overall health, health-related quality of life, and/or global well-being in a wide variety of health care contexts and conditions. Studies also varied in the outcomes reported and sometimes differed in their conceptualization or definition of the construct being assessed. Routine assessment of global well-being was comparatively less researched than overall health or health-related quality of life. Overall, the most studied whole-person outcome measures were brief assessment tools such as the EQ-5D, PROMIS-GH/10, and SF-12/36. Figure 2 shows the number of primary studies using each of these measures, stratified by clinical area.

FIGURE 2.

Number of primary studies using the EQ-5D, PROMIS-GH/10, and SF-12/36 by clinical area. MH/SUD indicates mental health/substance use disorder; PROMIS-GH/10, Patient Reported Outcomes Measurement Information System–Global Health or 10-item; SF-12/36, Short Form Health Survey 12 or 36-item.

Available research appears to offer a range of perspectives on the implementation, feasibility, and acceptability of whole-person outcome measures. These viewpoints are provided by patients (eg, alignment of assessment items with lived experience and satisfaction with assessments), providers (eg, usability of assessment results in care decisions and feasibility of conducting assessments), and to a more limited degree, organizational decision-makers and administrative staff (eg, challenges of integrating PRO measurement into clinical workflows). Relatively few studies explored the psychometric performance and validity of whole-person outcome measures, and because these properties can vary based on sample composition and setting, the generalizability of available performance evidence is unclear.

As noted earlier, the potential of routine whole-person outcome assessment to influence care decisions—and thereby enhance the quality and effectiveness of the care that is delivered—is of interest to health care providers and health systems alike. Despite this, no identified studies directly assessed whether information garnered from whole-person outcomes impacted clinical or disease outcomes. It is unclear whether the lack of assessment of clinical endpoints in studies of whole-person outcome measures is because measuring such outcomes is considered impractical (ie, study designs or settings limit researchers’ ability to causally link assessment, changes in care, and disease outcomes) or because modifying disease outcomes is not conceived of as the goal of general PRO assessment. For example, in an oncology setting, the primary purpose of measuring global well-being may be to enable providers to refer patients to mental health supports that are available to improve patient well-being. In this scenario, these services may have the intended benefit to well-being while having little or no impact on patient survival or other disease outcomes. Although it would be unusual for studies to provide rationales for not assessing certain outcomes, we suspect that both of these factors contribute to the lack of evidence in this area. One conclusion that can be drawn from the available evidence, therefore, is that more research is needed that is designed to evaluate the clinical impacts of whole-person outcome assessment. However, an alternative conclusion is that routine measurement of these outcomes is warranted because overall health, health-related quality of life, and global well-being appear to be useful and modifiable clinical parameters in their own right. In either case, it must be acknowledged that any benefits of whole-person outcome measurement during routine clinical care will depend on many factors outside of the assessment tool itself, including the quality of the patient-provider relationship, the ease with which a provider is able to make referrals to programs and services, and finally, whether such resources exist, have available capacity, and can be readily accessed by a patient.

Limitations

The purpose of this review was to provide an overview of research on the implementation and impacts of whole-person outcome measurement during routine inpatient or outpatient clinical care. As a rapid scoping review, we carried out sequential rather than fully independent dual review of search results to identify relevant literature, and we did not evaluate individual study risks of bias nor formally rate the certainty of available evidence. We also did not search for studies examining whole-person outcome measurement in emergent care settings, which might have provided more information about the extent of evidence on assessing whole-person outcomes during clinical care.

Future Research

The development of whole-person outcome measures that are suitable for broad use across health care contexts is an ongoing research area. For example, a recent study⁶³ of a novel generic measure of overall health and well-being, the EQ Health and Wellbeing, applied rigorous psychometric methods to assess measure performance across numerous health care settings in multiple countries. Nonetheless, the majority of identified studies implemented whole-person outcome assessment during the treatment of specific diseases or conditions. As a result, available studies may have limited utility when there is an interest in adopting a single whole-person outcome measure across a health system (1 ineligible study⁸ developed a PRO measure implementation framework for a “learning health care system”). Existing research also appears to provide limited insight into the performance, reliability, and other psychometric attributes of whole-person outcome measures in diverse and medically complex populations, such as those served by the U.S. Department of Veterans Affairs, the UK National Health Service, or other large integrated health systems. Future studies in health system settings could help to identify optimal measures and assessment modalities (ie, those that are most flexible across settings and best balance brevity and informativeness) and approaches for effectively using assessment results to inform care (ie, determining providers’ preferences for receiving results in the care setting). Additionally, studies examining measure validity and performance would benefit from the use of rigorous psychometric methods, in particular those available within the Item Response Theory framework.

CONCLUSIONS

Available evidence suggests that routine clinical assessment of whole-person outcomes is of broad interest to health care providers and health systems. Future research is needed to clarify optimal measures, assessment methods, and approaches to utilizing assessment results in health system settings. Although whole-person outcome measures are more informative about an individual’s overall state than symptom-specific PRO measures alone, most measures that have been used in clinical care to date provide limited information about broader social and structural factors that can affect patient health. Health systems and communities may have resources to help address some of these challenges—which can range from housing and food insecurity, to isolation and loneliness, to difficulty finding meaningful employment—and primary care and other health care providers could be well-positioned to make patients aware of such resources. Future research and implementation efforts that examine how best to identify and respond to a wider array of contributors to health would likely increase the impact of routine whole-person outcome assessment.