Table 3.

Examples and potential benefits and pitfalls of outcomes relevant to rheumatology POMs^*

Outcome categories	Examples	Potential benefits	Potential pitfalls
Intermediate outcomes	C-reactive protein level Erythrocyte sedimentation rate Active urinary sediment Complement studies Serum urate level	Often more easily captured/standardized than other assessments	Influenced by many factors May not reflect meaningful outcomes to patients or providers
Physician-reported outcomes	Swollen joint count Tender joint count Disease activity Functional status Physician global assessment	Better scores on assessments are often associated with improved long-term clinical outcomes	Variable reproducibility, potentially resulting in unreliable performance results Multiple similar instruments requiring either consensus regarding best metric or additional testing to define consistent results across metrics Variable burden of data collection
Patient-reported outcomes	Patient global assessment Pain visual analog scale Patient-Reported Outcomes Measurement Information System (PROMIS) 29-item health profile and functional assessment	Represent patient-centered outcomes	Variable reproducibility, potentially resulting in unreliable performance results Limited responsiveness data in rheumatic diseases available for newer instruments Variable burden of data collection
Safety	Adverse drug events Opportunistic infections Fragility fractures	Patients and providers usually agree they represent serious adverse outcomes	May be rare, making it difficult to accurately estimate performance May be influenced by many factors, making it challenging to attribute to individual provider
Experience with care	Access to care Timeliness of care Communication	Represent patient-centered outcomes	Do not provide information about quality of clinical care
Efficiency	Appropriate use of MRI in acute low back pain	Emphasizes guideline- concordant care to improve health care efficiency	May decrease appropriate as well as inappropriate care
Cost	Resource utilization during a discrete episode of care	Use with clinical POMs may offer insight into care value (quality/cost)	Unclear how to interpret (high cost separated from clinical outcomes is neither good nor bad)

^*POMs =performance outcome measures; MRI =magnetic resonance imaging.