A focus on patient-centered care and the patient experience. Part 2

How do we measure and improve the patient experience?

Patient-reported outcomes research is the science of measuring the patient experience using a new generation of research tools.  Patient-reported outcomes questionnaires are rigorously developed, reliable, responsive and valid questionnaires.  Internationally accepted guidelines for the development and validation of PRO questionnaires were created by the Scientific Advisory Committee of the Medical Outcome Trust in 2002 and the United States Food and Drug Administration in 2006.1  These PRO instruments allow physicians to accurately measure the effect of a procedure on quality of life, satisfaction, and psychosocial status - outcomes that were previously thought to be unmeasurable.

All PRO questionnaires are not alike.  An ad-hoc questionnaire is a PRO questionnaire that is not validated.  These questionnaires may have clinically reasonable questions, but the data does not have established validity and reliability.  It is important to use a high-quality, validated PRO instrument that has published data on its development, demonstrating that it meets the international guidelines.  Patient-reported outcomes questionnaires are the most sophisticated measurement tools in Facial Plastic Surgery. 

Unfortunately, in Facial Plastic Surgery, there is a paucity of PRO scales that meet international guidelines.  In 2009, Kosowski et al.2 performed a systematic review of Facial Plastic Surgery literature and reported on 9 PRO questionnaires that measure quality of life and/or patient satisfaction after procedures.  Only 1 scale demonstrated adequate formal development and validation but did not have adequate content validity index.  None of the scales satisfied all international guidelines for high-quality PRO questionnaires.  In 2010, Klassen et al.3 published the FACE-Q scales – 41 standalone PRO questionnaires across a wide range of surgical and non-surgical facial aesthetic procedures that meet all international guidelines. 

In practice, physicians choose PRO questionnaires based on the question to be answered.  A questionnaire that is condition-specific or specific to Facial Plastic Surgery has the potential advantage of higher sensitivity, precision, and responsiveness to clinical intervention.2,4  The goal is to gather meaningful data to improve one’s practice and provide the highest quality of patient-centered care. 

We encourage all facial plastic surgeons to have an operational definition of the patient experience and to use high-quality, validated PRO questionnaires specific to Facial Plastic Surgery to accurately measure and report outcomes.  At Archer Facial Plastic Surgery, patient-reported outcomes are used to improve the patient experience and the practice of patient-centered care. 

We want to hear from you! For questions and comments, please reach out to us on social (IG @archerfacialplastics, Twitter @ArcherMD, FB Kaete Archer, MD @archerfacialplastics) or email us at drarcher@archerfacialplastics.com!! 


  1. U.S. Food and Drug Administration. Patient Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims. 2009. Available at http://www.fda.gov/downloads/Drugs/GuidelineComplianceRegulatoryInformation/Guidances/ucm071975.pdf. Accessed March 23, 2015.
  2. Kosowski TR, McCarthy C, Reavey PL et al. A systematic review of patient-reported outcome measures after facial cosmetic surgery and/or nonsurgical facial rejuvenation. Plast Reconstr Surg. 2009 Jun;123(6):1819-1827.
  3. Klassen AF, Cano SJ, Scott A, Snell L, Pusic AL. Measuring patient-reported outomes in facial aesthetic patients: development of the FACE-Q. Facial Plast Surg. 2010 Aug;26(4):303-309.
  4. Rhee JS, McMullin BT. Measuring outcomes in facial plastic surgery: a decade of progress. Current Opinion in Otolaryngology and Head and Neck Surgery. 2008;16:387-393.
Kaete Archer, MD Facial Plastic Surgeon

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