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Administering and Scoring Process: Chapter 7

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In this excerpt (Chapter 7) from the PROTEUS-Practice Guide, you’ll learn about options for administering and scoring patient-reported outcome measures (PROMs).

This webpage contains the entire contents of Chapter 7. You can also download the PROTEUS-Practice Guide by clicking here.

Key Points

  • The available modalities to administer and score patient-reported outcome measures (PROMs) depend on whether collection is taking place during a clinical visit or remotely between visits
  • In the clinic, PROMs can be collected through self-administration on paper, interviewer administration, or computer-assisted administration. Remotely, PROMs can be collected by mail, by telephone, or online
  • Including quality and error checks in PROM administration can reduce missing data and invalid entries


PROMs can be administered across different settings and using different modalities. PROMs can be completed in the clinic, either through self-administration by the patient with paper-and-pencil, administration by an interviewer, or computer-assisted administration. PROMs can be completed remotely through the mail, by telephone, or online. While it is possible (and frequently advisable) to offer multiple approaches for PRO data collection, it is essential that data collected from the different approaches are merged.

In recent years, electronic collection has become the most common approach. For data collection that occurs online, such as through a patient portal, quality and error checks can be included in PRO administration to reduce missing data or invalid entries. Systems can monitor missing data and provide reports to care teams summarizing missing PROM responses from either individual patients or groups of patients. Systems can also alert the patient or care team when a particular PROM has not been completed by the patient.

Questions and Considerations

A. Where and how can PROMs be administered and scored?

In the clinic: self-administered on paper

  • Has low technology requirements and can be implemented in any clinical setting. Completion is relatively low-cost but requires more time and resources for data entry and processing
  • Can be challenging for patients with low literacy or those with other limitations that make it difficult to self-complete a survey
  • Has a higher chance of returning missing/unusable data as patients independently complete the forms without a validity check from an interviewer or computer system

In the clinic: interviewer administered

  • Offers a more personal experience to patients
  • Largely overcomes barriers of self-administration for in-clinic completion
  • Requires a private physical space in which to administer the PROM, as well as trained personnel to administer and score the PROMs
  • Requires significant additional human resources
  • May introduce social desirability bias

In the clinic: computer assisted

  • Offers a standardized approach for collecting PROMs with less potential for bias than live interviewers
  • Simultaneously captures and stores responses
  • Requires personnel to provide support with the data collection device (computer, tablet) and a private space for completion
  • Can lead to challenges dealing with technological malfunctions (e.g. device, internet access, etc.)
  • May have higher costs than paper administration as it requires purchasing the PRO software and the devices to run it on, but fewer resources for data input and processing

By mail: Self-administered

  • May be simpler than administration during clinic visits and has low-technology requirements
  • Likely has a higher non-response rate and is subject to other limitations of self-administered surveys in the clinic and may be subject to lower data quality caused by transcription error
  • Less likely that the care team can respond in a reasonable time frame if the patient has clinically actionable results

By telephone: interview administered

  • Offers a more personal experience to report PROs
  • Largely overcomes barriers to completing PROMs caused by low-literacy or visual impairment
  • Requires trained personnel to administer survey

By telephone: voice activated prompts

  • Offers a standardized approach for collecting PROMs with less potential for bias than live interviewers
  • Largely overcomes barriers to completing PROMs caused by low-literacy or visual impairments
  • Requires upfront costs to develop/purchase an interactive voice response system that can return PRO results to the clinic, but once established has a relatively low cost
  • May decrease patient satisfaction
  • Potentially limits data completeness for PROMs that are lengthy or have complex responses as they may take substantial time to complete

Online: self-administered on patient’s personal device outside of clinic

  • Simultaneously captures and stores responses
  • Allows for flexibility in timing of data collection
  • Can be developed to immediately alert staff regarding completion and possible alerts on scores
  • Requires a secure platform to house and collect data on PROMs
  • Requires personnel to manage the system

Using a combination of approaches

  • Accommodates the different preferences or abilities of patients to complete PROMs
  • Uncertainty amongst staff as to what system each specific patient is using
  • Requires that data collected from different approaches are merged and housed in an integrated fashion

B. What quality and error checks can be included in computer assisted/online PRO administration?

  • Range and format checks can be used to reduce invalid entries
  • Requiring responses before moving to the next question can reduce missing data, but prevents individuals from opting-out of questions they would prefer not to answer

C. How can the system monitor compliance/alert to missing questions?

Reports of completion rates

  • Can be generated to report how many/often a patient or group of patients (e.g. all patients in a particular practice) complete PROMs
  • Can be used to inform quality improvement of the PRO system
  • Depends on having technological capability to aggregate material for reports and distribute them

Automated messages when patients do not complete PROMs

  • Sends notification or email to the patient and/or clinical care team alerting that a patient’s PRO questionnaire is missing
  • Provides a prompt to go back and capture missing information
  • Depends on having technological capability to identify when to flag a questionnaire as incomplete, and alert the patient/care team

Relevant Primary Resources

The information presented here is an overview of administration and scoring. For more detailed information please see the following sources:

Background And Citing The Proteus-Practice Guide

Nothing in this Guide should be construed to represent or warrant that persons using this Guide have complied with all applicable laws and regulations. All individuals and organizations using this template have the responsibility for complying with the applicable laws and regulations or regulatory requirements for the relevant jurisdiction.

Each chapter of the Guide lists the key foundational resources that informed its content. To appropriately recognize the foundational resources, we encourage you to cite both the Guide and the relevant foundational resource(s). Recommended citations are provided here.

Suggested Citation

The PROTEUS Guide to Implementing Patient-reported Outcomes in Clinical Practice
A synthesis of resources. Prepared by Crossnohere N, Brundage M, Snyder C, and the Advisory Group, 2023. Available at:

Further Reading

The Guide draws primarily from the foundational resources cited in each chapter. Please click here to find a selection of other relevant references.

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