Methods to Aid PRO Score InterpretationApplying PRO Reference Values to Communicate Clinically Relevant Information at the Point-of-careJensen, Roxanne E. PhD*; Bjorner, Jakob B. MD, PhD†Author Information *Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD †Optum Patient Insights, Johnston, RI Research by R.E.J. presented in this paper was supported by KL2TR001432 and P30CA051008 before joining the National Cancer Institute. This paper is part of the PRO-cision Medicine Methods Toolkit paper series funded by Genentech. The PRO-cision Medicine Methods Toolkit paper series was presented during a symposium at the 2018 Annual Conference of the International Society for Quality of Life Research, Dublin, Ireland. J.B.B. is an employee of Optum Patients Insights, the distributor of the SF-36v2. R.E.J. declares no conflict of interest. Reprints: Roxanne E. Jensen, PhD, 9609 Medical Center Drive, Rockville, MD 20850. E-mail: [email protected]. Medical Care: May 2019 - Volume 57 - Issue - p S24-S30 doi: 10.1097/MLR.0000000000001113 Buy Metrics Abstract Introduction: The inclusion of reference values for common patient-reported outcomes (PROs) measures in clinical care settings provides a clinically relevant context for an individual patient’s PRO scores. PRO reference values are currently not reported in clinical care settings. This is a missed opportunity, as clinicians are familiar with the presence and interpretation of reference values, commonly provided alongside laboratory test results. Incorporating PRO reference values into clinical PRO reporting requires: an understanding of the clinical purpose, the availability of an appropriate reference value, and graphical representation. Methods for PRO Score Interpretation: We present reference value terminology adapted for PROs and discuss important differences between using reference values in the PRO score interpretation compared to other types of clinical measures from clinical chemistry. We outline the basic methodological approaches in obtaining a PRO reference sample and calculating reference intervals. Lastly, we provide recommendations on how to present and use PRO reference values in clinical care settings. Discussion: There is a strong, long-standing discipline behind reference value development and application in psychology and medicine, allowing for both providers and patients to understand comparisons and identify what is “out of range.” PRO reference values can be communicated in a wide range of ways within clinical care settings and are adaptable as required to different patient populations or clinical care situations. However, a notable adoption barrier is the expense and methodological expertise needed to establish and apply PRO reference values effectively in clinical encounters. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.