Patient-oriented outcome measurement in chronic diseases: Conceptual basis and empirical evidence

In this paper we describe a method with which to measure patient-oriented change in chronic diseases, namely the POEM approach. It is not intended to replace standard procedures for determining the effects of interventions, but rather to expand upon them by introducing additional items and analyses that provide individualised information and patient-oriented judgments of significance. The POEM approach has three steps: 1) assessing patient health valuations prior to intervention, 2) assessing the participation relevance of changes experienced after intervention, and 3) evaluating and reporting the effects weighted according to health valuations and participation relevance. We present the fundamental idea behind the POEM approach by contrasting it with standard methods and provide examples of the operationalization of health-valuation and judgments of participation relevance. Neither the basic premise of the POEM approach nor its elements represent any genuinely new method not already discussed in the literature. What we do believe is innovative, however, is twofold, namely a) the integrated consideration of health valuation and participation relevance as a basis for measuring patient-oriented change, and b) the fact that we relate patient-centred judgments of relevance to the concept of participation, which plays a key role in chronic diseases. We summarise and evaluate the results from our empirical investigations of the POEM approach. Further research should be designed to evaluate the stability of patient preferences, and how best to deal with divergent methods used to determine preferences and relevance appraisals, some of which converge poorly.