The case for a new generation of short generic patient-reported quality measures, covering HRQoL, experience and engagement. Shows key findings from the 9-year programme to develop howRu, howRwe and the Health Confidence Score

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Short Generic Patient-Reported Quality
Measures
Tim Benson
R-Outcomes Ltd
Oxford International Health Conference
27 June 2015
St Hugh’s College Oxford

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Outline of Presentation
Short summary of programme since 2006
Three aspects of patient perception
Health-related quality of life (howRu)
Health Confidence Score (HCS)
Patient experience (howRwe)
Data collection
Feedback to improve quality and outcomes
Disclosures
Tim Benson developed the tools and is a director of of R-Outcomes Ltd.
The tools were developed without public money or other sponsorship.

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Health-Related
Quality of Life
Health
Confidence
Patient
Experience
Three aspects of patient
perception

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Everyone wants
To feel better and be able to do more
(and a long life followed by a peaceful death)*
And receive excellent service
Most also want to be fully engaged in their care
We should measure quality against these criteria
* not discussed in this presentation

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Require help from others
How are you today? (past 24 hours)
Limited in what you can do
Feeling low or worried
Pain or discomfort
None A little
Quite
a lot
Extreme
Choose one answer to each question
howRu
A short generic patient-reported
outcome measure (PROM)
1 Physical symptoms
2 Mental symptoms
3 Disability
4 Dependency
Benson T et al. Evaluation of a new
short generic measure of health
status: howRu. Inf Prim Care 18 (2)
89-101. PDF

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Validation vs SF-12 and EQ-5D
-0.4
-0.2
0.0
0.2
0.4
0.6
0.8
1.0
40
60
80
100
120
0 1 2 3 4 5 6 7 8 9 10 11 12
Mean
EQ-5D
Mean
SF-12
howRu Score (actual)
Actual howRu scores vs mean SF-12 and EQ-5D-3L
SF12 (n=2751) EQ-5D (n=116) SF-12 trend EQ-5D trend
Sources:
SF-12 vs howRu: Benson T et al. Evaluation of a new short generic measure of health status: howRu. Inf Prim Care 18 (2) 89-101. PDF
EQ—5D vs howRu: Benson T et al. Comparison of howRu and EQ-5D measures of health-related quality of life in an outpatient clinic.
Inf Prim Care 2013; 21 (1) 12-17. PDF

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Change between Pre-op and Post-op scores
Measure on 0-100 scale
Hip
Replacement
improvement
Knee
Replacement
improvement
Oxford hip and knee scores* 43 34
howRu** 33 26
EQ-5D*** 26 19
EQ-VAS*** 10 5
0-100 scale allocates 0 to worst state and 100 to best state
* Mean value for cohorts using howRu and EQ-5D (unweighted)
** Mean value for 74 hip and 42 knee replacements
*** Mean value for 29,129 hip and 29,907 knee replacements (NHS PROMs database)

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Correlations between generic and condition-specific
measures for the difference between pre-operation
and post-operation scores
Generic vs Condition-specific
Hip
Replacement
(r)
Knee
Replacement
(r)
howRu vs Oxford score 0.78 0.86
EQ-5D vs Oxford Score 0.67 0.59
EQ-VAS vs Oxford Score 0.33 0.31

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howRu index is aggregate score of howRu dimensions for each home converted to 0 (all at worst score) to 100 (all at best score)
Benson T, Bowman C. Health-Related Quality of Life and Patient Experience in Care Homes. Medicine 2.0 London, Sept 2013

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Health Confidence
Score (HCS)
Short generic measure of
patient’s perception of their
confidence to engage fully in
health and care.
1 Knowledge
2 Self-management
3 Access
4 Shared decision-making

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How are we doing?
See you promptly
Well organised
Listen and explain
Treat you kindly
Excellent Good Fair Poor
Choose one answer to each question
howRwe
Short generic measure of patient
experience:
Clinical relationships
1 Kindness
2 Communication
Admin function
3 Promptness
4 Organisation
Benson T, Potts H. A short generic
patient experience questionnaire:
howRwe development and
validation. BMC Health Services
Research 2014, 14:499 PDF

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howRwe index is aggregate score of howRwe dimensions for each home converted to 0 (all at worst score) to 100 (all at best score)
Benson T, Bowman C. Health-Related Quality of Life and Patient Experience in Care Homes. Medicine 2.0 London, Sept 2013

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This shows howRwe dimension scores before making a change to the way that the clinic was run.
Benson T, Potts HWW. A short generic patient experience questionnaire: howRwe development and
validation. BMC Health Services Research 2014, 14:499 PDF

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No change in clinical domains (kindness and communication). Significant improvement in
administrative domains (promptness and organisation).
Benson T, Potts HWW. A short generic patient experience questionnaire: howRwe development and
validation. BMC Health Services Research 2014, 14:499

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Design Criteria
Short
Quick and easy to use
Low burden
Repeated use
Generic
All conditions
Multiple conditions
All settings including social care
howRu Health Tracker

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Data collection modalities
Patient’s own device
using text or email invitation
smartphone, PC or tablet
Provider’s device
kiosks, tablets or PCs
Paper
Optical Mark Readable (OMR) forms
Paper forms or postcards
Telephone
human or interactive voice response (IVR)
Add to other surveys

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Length

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Automation
Automation reduces burden on staff and patients
Data collection
Registration and consent
Schedule frequency or trigger events
Send patient invitation
Patient completes and submits
Analysis
Results reception, validation and alerts
Add to EHR (Read or SNOMED CT coded)
Analytics and dashboards
Feedback

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Feedback
Rapid easy-to-understand feedback is essential
to improve quality and outcomes
For all stakeholders
Patients and their families
Clinicians for clinical care and audit
Managers for quality assurance and improvement
Commissioners for value and accountability
The whole thing is waste unless people make
different (better) decisions

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Summary
Summary of a nine-year development
programme
Recognised the need for short generic PROMs
that are fit for purpose
Validation studies show good results
We now have a practical tool set

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For more information
or to use these tools
please contact us
Email info@r-outcomes.com
Tel +44 7855 682 037
Web www.r-outcomes.com
Twitter @r_outcomes