Implementation in Non-Research Settings.


As indicated in other portions of these Web pages, there are a number of potential uses for instruments such as the VR-36©, VR-12© and VR-6D© in both research and non-research (clinical) settings. This section provides information on recent, ongoing, and anticipated implementation in non-research settings. In general, such implementation has been used to assist in the measurement of provider and system performance, but in those settings in which individual providers are aware of the results from specific patients, it may also be of use in individual clinical management.

Federal incentive programs specifying use of Patient-Reported Outcome Measures

The U.S. Centers for Medicare and Medicaid Services (CMS) has created two incentive programs in which patient-reported measures of health status play an important role. Specifically, the VR-12© and VR-36© are among those instruments listed that will satisfy the program requirements for certain specified medical conditions. The current programs are indicated below. (Note: Specifications for these programs, including “stages” of the program and effective dates, may change over time, and those interested should check the relevant Web pages for updates. Last checked on 11/10/2016)

1. CMS Electronic Health Record (EHR) Incentive Program

The specific conditions for which patient-reported outcome measurements are specified include:

  • Hip replacement
  • Knee replacement
  • Complex chronic medical conditions (heart failure, at present)

2. The Physician Quality Reporting System (PQRS)

For certain providers who are involved with the EHR incentive program, similar sets of conditions and outcome measures can be used for the PQRS program.

For both the EHR incentive program and the PQRS program, the relevant patient-reported outcome measures are described in more detail in the Health and Human Services Measure Inventory on Web pages affiliated with the Agency for Healthcare Research and Quality (AHRQ). The following links correspond to the three conditions indicated above under the EHR Incentive Program:

3. CMMI Comprehensive Care for Joint Replacement Model (CMS Innovation)

The VR-12© is part of the generic Patient Reported Outcome Measures (PROM) for total hip replacement and total knee replacement used to adjust bundled-payments for quality performance.

Non-research implementation

Medicare Health Outcomes Survey (HOS)
  • Since 1998, the Medicare HOS has been administered to a randomly-selected sample of members of Medicare Advantage (MA) plans. Each sample is surveyed twice, once at baseline and again two years later. Among the current questions on the HOS is the VR-12©, which was substituted for the SF-36© (version 1.0) in the spring of 2006. The VR-12© is the major end point for measuring the performance of MA plans. The HOS website ( provides more details, and you learn more about the use of the VR-12© in the HOS here:
  • Two of the main outcome measures of the HOS involve the PCS and MCS. In particular, Medicare Advantage plans are judged on the proportion of member respondents who have stable or improved PCS and MCS scores between the baseline and follow-up surveys.
  • For the purpose of comparing these measures among Medicare Advantage plans, scores are processed with appropriate case-mix adjustments. In addition, the PCS measure is further combined with a measure of mortality to create a combined measure “alive and PCS same or better”.
  • Additional descriptions of these PCS and MCS 2-year change measures, with categories of better, same or worse than expected, are listed on the National Measure Quality Clearinghouse (NMQC) Inventory.
  • The Medicare Health Outcomes Survey: percentage of members whose health status was “better than expected,” “the same as expected” or “worse than expected” at the end of a two-year period:
  • The Medicare Health Outcomes Survey-Modified: percentage of members whose health status was “better than expected,” “the same as expected” or “worse than expected” at the end of a two-year period:
  • The second of the above two measures corresponds to the HOS-Modified which is administered to individuals in “PACE Organizations” and who are at greater risk of poor health outcomes. More about the HOS-M can be found at:
  • NMQC is an initiative of the Agency for Healthcare Research and Quality (AHRQ) and has specific inclusion criteria for its measure inventory, as indicated at the following Website:
  • SEER-MHOS datasets: The National Cancer Institute has linked HOS data to the SEER database which contains certain detailed information on individuals diagnosed with cancer. More information about this database can be found at the following Webpage:
U.S. Department of Veterans Affairs (VA)
The VA Survey of Healthcare Experiences of Patients (SHEP)

For a number of years, the Veterans Health Administration (VHA) has administered the Survey of Healthcare Experiences of Patients (SHEP) to VHA patients. In the past, the SHEP has contained either the VR-36© or VR-12©. Currently, there are several versions of the SHEP and the version containing the VR-12© is the outpatient/ambulatory care “long form” which is administered to approximately 5% of SHEP survey recipients. More information about the current SHEP survey can be found at the following websites:

The VR-12© is also included among survey instruments within the VA’s electronic health record (called the Computerized Patient Record System, or CPRS) to aid VHA physicians in evaluating patients.

As noted in section 3.3.2, the VR-12© and VR-36© are among the potential measures that can be used to satisfy requirements for certain aspects of the EHR Incentive Program and the PQRS Program. While no data is currently available regarding the use of these surveys for these programs, it is anticipated that at least some providers will choose to use the VR-12© or VR-36© for evaluation and reporting purposes.

Canadian Government

The Canadian Institute of Health Research (CIHR) actively promotes the use of Patient Reported Outcomes Measures (PROs) as part of their Patient-Oriented Research strategy. It explores effective ways to measure patient health outcomes of primary health care integration, as well as ways to address the challenges of integration and utilization of PROs. The Canadian government is considering the implementation of the VR in the near future.