Research Project

Developing Quality Metrics from Patient-Reported Outcomes (PROs) for Medical Rehabilitation

Posted By Kristian P. Nitsch

Why is this study needed?


Healthcare quality in the United States varies widely; this variation has created calls for performance improvement and provider accountability to improve care quality. The only way to know if healthcare quality is improving is to document performance using standard quality measures. Quality measures permit comparisons of how well hospitals deliver care. Quality measures are used for public reporting, quality improvement, and hospital payments.

Patient-reported outcome measures (PROMs) provide valuable information for describing health changes during rehabilitation hospitalization. However, inpatient rehabilitation facilities primarily rely on clinician-rated outcomes, such as functional status and goal attainment; the patient’s voice is therefore often not a part of hospital evaluations. There are major challenges to using PROMs for accountability and performance improvement, including limited use in clinical practice and uncertainty about how to aggregate PROMs for performance improvement. The feasibility of patients providing and staff collecting PROMs as part of routine care has not been demonstrated.

How will this study help patients and rehabilitation stakeholders?


This proposal addresses this lack of information by identifying issues that are important to the quality of care for rehabilitation patients that could be collected as patient-reported outcomes. We will evaluate the feasibility of collecting PROMs, and identify what questions are required for quality measure development.

What are the project aims?


  • To identify important issues for the quality of care of rehabilitation patients that are amenable to being collected via PROMs.
  • To evaluate the feasibility of collecting PROMs.
  • To specify items required for quality measure development and design data collection modules that can be used in quality improvement efforts and to demonstrate accountability of health care delivery.

How will the project aims be achieved?


This utilizes a mixed methods design involving focus groups, key informant interviews, and primary data collection with a sample of 300 neurorehabilitation inpatients. An Advisory Committee comprised of key stakeholders – patients, patient advocacy organizations, clinicians, professional associations and policy makers –  provide key input throughout the study. Research questions and hypotheses identify which quality concepts are relevant to patients served by inpatient rehabilitation facilities, the instruments that best operationalize these concepts, the priorities for quality measures for rehabilitation patients, the quality measures that can be derived from PROM items and instruments that are appropriate for rehabilitation patients that fulfill NQF’s quality measure criteria, and the case mix factors rehabilitation stakeholders deem to be critical in constructing quality measures.

Funded by:


Patient-Centered Outcomes Research Institute

What is the duration of the project?


May 1, 2013 – July 30, 2017

Primary Project Staff


Allen W. Heinemann, Ph.D., Director, Center for Rehabilitation Outcomes Research

Co – Investigators:

David Cella, PhD. Assistant Professor Neurology, Northwestern University, Department of Medical Social Sciences

Deutsch Anne, Ph.D., Clinical Research Scientist, Center for Rehabilitation Outcomes Research

Karon Cook, PhD., Research Associate Professor, Northwestern University, Department of Medical Social Sciences

Linda Foster, PT, Alexian Brothers Rehabilitation Hospital

Ana Miskovic, Center for Rehabilitation Outcomes Research

Contact Information


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