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Patient reported outcomes | Andrew Vallance-Owen
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Patient reported outcomes | Andrew Vallance-Owen

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A presentation by Andrew Vallance-Owen on Patient Reported Outcomes at the diagnosis Salon on 28th April.

A presentation by Andrew Vallance-Owen on Patient Reported Outcomes at the diagnosis Salon on 28th April.

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  • 1. PATIENT REPORTED OUTCOMES International Forum on Quality and Safety in Healthcare Breakfast Session Andrew Vallance-Owen Group Medical Director 7 April 2011
  • 2.  
  • 3.  
  • 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
  • 5. EQ-5D Kind, P. et al. BMJ 1998;316:736-741
  • 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
  • 7. VF-14 (Visual Function) – extract from 14 questions
  • 8. Baseline data can be interesting in their own right: VF-14 pre-op scores, where 100 = no visual problems 0 10 20 30 40 50 60 70 80 90 100 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) VF-14 score (100 = no visual problems)
  • 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
  • 10. Recruitment varies by procedure % of patients completing baseline questionnaire, NHS data Hips and knees – 70 to 80% Hernia – 50 to 60% Varicose vein – 40 to 50%
  • 11. EQ-5D responsiveness? Note number “Same” and “Unknown” … compared with condition-specific tools:
  • 12. How NHS data have been presented (as experimental statistics) http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295
  • 13. How the NHS data can be shown - funnel plot Oxford Hip change scores by hospital, April ’09 to April ’10 data NHS Experimental Statistics
  • 14. The future of PROMS? The ‘howRu’ howRu 35 words EQ-5D 230 words SF-12 451 words SF-36 779 words