PATIENT REPORTED OUTCOMESInternational Forum on Quality and Safety in HealthcareBreakfast SessionAndrew Vallance-OwenGroup Medical Director7 April 2011

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 2

BUPA Hospitals rates for clinical indicators(Most indicators <0.5% of discharges)

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Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 3

BUPA Hospitals rates for clinical indicators(What about the other 99.5% of patients?)

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Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 4

Generic questionnaire used by NHS

EQ-5D

• 5 questions and a visual analogue scale

• Disadvantage:

◦ Not as sensitive

• Advantage:

◦ Can convert data into QALYs for health economics

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 5

EQ-5D

Kind, P. et al. BMJ 1998;316:736-741

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 6

Disease-specific vs. generic tools

Trade-off between:

• measuring all health issues affecting patients, and

• using the tool most sensitive to the expected change

Cataracts for example:

• SF-36 shows cataract surgery having negligible benefit, whilst:

• VF-14 shows the same surgery making significant improvement

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 7

VF-14 (Visual Function) – extract from 14 questions

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 8

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0 3 5 8 11 13 16 19 21 24 27 29 32 35 38 40 43 46 48 51 54 56 59 62 64 67 70 72 75 78 80 83 86 88 91 94 96 99

Percentage of patients (N=824)

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-14

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(10

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s)Baseline data can be interesting in their own right:VF-14 pre-op scores, where 100 = no visual problems

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 9

PROMS - NHS

Standard NHS Contract for Acute Services, April 2008

requirement to report from April 2009 :

•Other procedures may be added later, e.g. cataract surgery•Future - Long term conditions in primary care

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 10

Recruitment varies by procedure% of patients completing baseline questionnaire, NHS data

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Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10

Groin Hernia Hip Replacement Knee Replacement Varicose Vein

Hips and knees – 70 to 80%

Hernia – 50 to 60%

Varicose vein – 40 to 50%

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 11

EQ-5D responsiveness?

Note number “Same” and “Unknown”

Oxford /

Aberdeen

Change (%)

Groin

Hernia

Hip

Replacement

Knee

Replacement Varicose Vein

Increase 95.8% 91.6% 83.7%

Same 0.6% 1.4% 0.1%

Decrease 3.6% 7.0% 16.3%

Unknown 2.5% 3.6% 2.9%

EQ-5D Index

Change (%)

Groin

Hernia

Hip

Replacement

Knee

Replacement Varicose Vein

Increase 49% 87% 77% 53%

Same 33% 6% 11% 33%

Decrease 18% 7% 12% 14%

Unknown 6% 11% 11% 8%

… compared with condition-specific tools:

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 12

How NHS data have been presented (as experimental statistics)http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295

Groin Hernia - EQ-5D Index - Adjusted Health Gain

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Organisation A National Organisation B

Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 13

How the NHS data can be shown - funnel plotOxford Hip change scores by hospital, April ’09 to April ’10 dataNHS Experimental Statistics

Hip replacement outcomes (OHS)

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Volume (Linked Q1-Q2-HES)

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Patient Reported Outcomes – International Forum on Quality and Safety in Healthcare – Amsterdam 2011 7 April 2011 14

The future of PROMS? The ‘howRu’

howRu 35 words

EQ-5D 230 words

SF-12 451 words

SF-36 779 words