Implementing Patient Reported Outcome Measures in a Student-Faculty Clinic

  • Michael Milligan Harvard Medical School
  • David E. Wang
  • Yannis K. Valti
  • Chanan Reitblat
  • Esther H. Chung
  • Enrico G. Ferro
  • Eugene Vaios
  • Biqi Zhang
  • Mary K. Abel
  • Olive Tang
  • Marya Cohen


Patient reported outcome measures (PROMs) capture patient perspectives of care, unfiltered by healthcare providers. By quantifying how care impacts each patient’s mental, physical, and social wellbeing, PROMs can serve as a powerful indicator of healthcare quality. While PROMs have been implemented in a number of hospital settings, their use in student-faculty clinics has not been reported. This manuscript thus describes the implementation of a novel set of PROMs questionnaires at the Crimson Care Collaborative (CCC) at Harvard Medical School (HMS). Based on our experiences and a thorough review of other PROMs implementations, we determined three main requirements for a successful launch: a specific approach tailored to each unique clinic setting, strong clinician buy-in, and widespread patient acceptance. Once implemented in our clinic, we discovered that PROMs benefitted medical education by increasing awareness of the social determinants of health, and encouraging students to broach difficult conversations. We expect that the continuous use of PROMs at CCC will inspire future quality improvement projects, and believe that our implementation experience can serve as a guide for other student-faculty clinics. 

Author Biography

Michael Milligan, Harvard Medical School
Michael Milligan is an MD/MBA Candidate at Harvard Medical School


Weldring T, Smith SMS. Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Services Insights. 2013;6:61-86.

Wu AW, Jensen RE, Salzberg C, Snyder C. Advances in the Use of Patient Reported Outcome Measures in Electronic Health Records. PCORI National Workshop to Advance the Use of PRO Measures in Electronic Health Records. November 7, 2013.

Detmar, SB, Muller MJ, Schornagel JH, Weaver LD, Aaronson NK. Health-Related Quality-of-Life Assessments and Patient-Physician Communication: A Randomized Controlled Trial. JAMA. 2002;288(23):3027-3034.

Berman R, Powe C, Carnevale J, et al. The Crimson Care Collaborative: A Student-Faculty Initiaive to Increase Medical Students’ Early Exposure to Primary Care. Acad. Med. 2012;87(5):651-655.

Wagle N. Implementing Patient-Reported Outcome Measures. NEJM Catalyst. November 17, 2016.

Health Measures. NIH PROMIS. Accessed May 1, 2017.

Spitzer R., Kroenke K.,Williams J. Validation and utility of a self-report version of PRIME- MD: The PHQ Primary Care Study. JAMA. 1999;282(18):1737–1744.

Patient Helath Questionnaire (PHQ) Screeners. Pfizer. Accessed on May 1, 2017.

Clarke R, Hackbarth AS, Saigal C, Skootsky SA. Building the Infrastructure for Value at UCLA: Engaging Clinicians and Developing Patient-Centric Measurement. Acad Med. 2015;90(10):1368-1372.

Lee V, Miller R, Daniels C, et al. Creating the Exceptional Patient Experience in One Academic Health System. Acad. Med. 2016;91(3):338-344.

Ryskina J, Meah YS, Thomas DC. Quality of Diabetes Care at a Student-Run Free Clinic. J Health Care Poor Underserved. 2009;20(4):969-981.

Zucker J, Gillen J, Ackrivo J, Schroeder R, Keller S. Hypertension Management in a Student-Run Free Clinic: Meeting National Standards? Acad. Med. 2011;86(2):239-245.

Liberman KM, Meah YS, Chow A, Tornheim J, Rolon O, Thomas DC. Quality of Mental Health Care at a Student-Run Free Clinic. Acad. Med. 2011;36(5):733-740.

Zucker J, Lee J, Khokhar M, Schroeder R, Keller S. Measuring and Assessing Preventative Medicine Services in a Student-Run Free Clinic. J Health Poor Underserved. 2013;24(1):344-358.

Butala NM, Chang H, Horwitz LI, Bartlett M, Ellis P. Improving Quality of Preventative Care at a Student-Run Free Clinic. PLoS One. 2013;8(11):e81441.

Porter M, Larsson S, Lee TH. Standardizing Patient Outcomes Measurement. NEJM. 2016;374:504-506.

Antunes B, Harding R, Higgingson IJ. Implementing Patient-Reported Outcome Measures in Palliative Care Clinical Practice. Palliat Med. 2014;28(2):158-175.

Cox A, Illsley M, Knibb W. The Acceptability of e-Technology to Monitor and Assess Patient Symptoms Following Palliative Radiotherapy for Lung Cancer. Palliat Med. 2011;25:675-681.

Chang CH, Cella D, Masters CA. Real-Time Clinical Application of Quality-of-Life Assessment in Advanced Lung Cancer. Clin Lung Cancer. 2002;4:104-109.

Clark K, Bardwell WA, Arsenault T, DeTeresa D, Loscalzo M. Implementing Touch-Screen Technology to Enhance Recognition of Distress. Psycho-Onc. 2008;18(8):822-830.

Mazur S, Bazemore A, Merenstein D. Characteristics of Early Recipients of Patient-Centered Outcomes Research Institute Funding. Acad. Med. 2016;91(4):491-496.

Westerhaus M, Finnegan A, Haidar M, Kleinman A, Mukherjee J, Farmer P. The Necessity of Social Medicine in Medical Education. Acad. Med. 2015;90(5):565-568.

O’Brien MJ, Garland JM, Murphy KM, et al. Training Medical Students in the Social Determinants of Health. Adv Med Educ Pract. 2014;5:307-314.

Sheu L, O’Brien B, O’Sullivan PS, Kwong A, Lai CJ. Systems-Based Practice Learning Opportunities in Student-Run Clinics. Acad. Med. 2013;88(6):831-836.

Kane J, Brannen M, Kern E. Impact of Patient Safety Mandates on Medical Education in the United States. J Patient Safety. 2006;4(2):93-97.

Kitto S, Goldman J, Etchells E, et al. Quality Improvement, Patient Safety, and Continuing Education. Acad. Med. 2015;90(2):240-245.

Wetherhold J. Embedding Quality Improvement in Medical Education: Our 90-day Report. Institute for Healthcare Improvement.

/ihi/community/blog/itemview.aspx?List=84e15604-08bf-4317-8323-cf46b485b7c0&ID=8. Accessed May 1, 2017.

McKenna SP. Measuring Patient-Reported Outcomes: Moving Beyond Misplaced Common Sense to Hard Science. BMC Med. 2011;9:86.

Wolpert M. Uses and Abuses of Patient Reported Outcome Measures. Adm Pol in Mental Health. 2014;41:141-145.

How to Cite
Milligan, M., Wang, D., Valti, Y., Reitblat, C., Chung, E., Ferro, E., Vaios, E., Zhang, B., Abel, M., Tang, O., & Cohen, M. (2017). Implementing Patient Reported Outcome Measures in a Student-Faculty Clinic. Free Clinic Research Collective, 3(1). Retrieved from