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.

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Patient reported outcomes | Andrew Vallance-Owen

  1. 1. PATIENT REPORTED OUTCOMES International Forum on Quality and Safety in Healthcare Breakfast Session Andrew Vallance-Owen Group Medical Director 7 April 2011
  2. 4. Generic questionnaire used by NHS <ul><li>EQ-5D </li></ul><ul><ul><li>5 questions and a visual analogue scale </li></ul></ul><ul><ul><li>Disadvantage: </li></ul></ul><ul><ul><ul><li>Not as sensitive </li></ul></ul></ul><ul><ul><li>Advantage: </li></ul></ul><ul><ul><ul><li>Can convert data into QALYs for health economics </li></ul></ul></ul>
  3. 5. EQ-5D Kind, P. et al. BMJ 1998;316:736-741
  4. 6. Disease-specific vs. generic tools <ul><li>Trade-off between: </li></ul><ul><ul><li>measuring all health issues affecting patients, and </li></ul></ul><ul><ul><li>using the tool most sensitive to the expected change </li></ul></ul><ul><li>Cataracts for example: </li></ul><ul><ul><li>SF-36 shows cataract surgery having negligible benefit, whilst: </li></ul></ul><ul><ul><li>VF-14 shows the same surgery making significant improvement </li></ul></ul>
  5. 7. VF-14 (Visual Function) – extract from 14 questions
  6. 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)
  7. 9. PROMS - NHS <ul><li>Standard NHS Contract for Acute Services, April 2008 </li></ul><ul><li>requirement to report from April 2009 : </li></ul><ul><li>Other procedures may be added later, e.g. cataract surgery </li></ul><ul><li>Future - Long term conditions in primary care </li></ul>
  8. 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%
  9. 11. EQ-5D responsiveness? Note number “Same” and “Unknown” … compared with condition-specific tools:
  10. 12. How NHS data have been presented (as experimental statistics) http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295
  11. 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
  12. 14. The future of PROMS? The ‘howRu’ howRu 35 words EQ-5D 230 words SF-12 451 words SF-36 779 words

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