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. Author manuscript; available in PMC: 2014 Aug 1.
Published in final edited form as: Med Care. 2013 Aug;51(8 0 3):S73–S79. doi: 10.1097/MLR.0b013e31829b1d84

TABLE 1.

Challenges and solutions for using PRO in PCOR

Challenge Proposed Solutions for Policy, Research, and Practice
Comprehensive, uniform adoption of PRO

  • Funding agency, FDA, payor, accreditor requirement for PRO data collection for specified conditions

  • Reimbursement and billing for PRO data collection

  • Research to establish process-outcome linkage for specified conditions

  • Bundle PROs with clinical measures for specified conditions
Selection of PRO

  • Consensus on recommended PROs for specified conditions and situations

  • Research on psychometric properties, natural history, heterogeneity
Proprietary measures

  • Studies to compare proprietary to public domain measures

  • Begin with PROs currently in use, in public domain, or copy-left
Clinical interpretation

  • Research on clinical interpretation

  • Engage clinicians and patients/family members
Literature synthesis/meta analysis

  • Research on meta analysis methods for PROs
Confidentiality

  • Establish standard procedures to evaluate PROs

  • Research on stakeholder preferences

  • Obtain input from patients and clinicians
Coordination among organizations

  • Create data sharing consortia
Data linkage

  • Research studies on data linkage
Missing data

  • Establish guidance for handling

  • Research studies on impact of missing data; imputation