1) The document provides background on the national PROMs (patient-reported outcome measures) programme in the UK, which collects data on patient outcomes and experiences before and after various surgical procedures.
2) It discusses how PROMs data can be used to identify variations in outcomes across different provider trusts nationally and help trusts investigate areas for improvement.
3) It presents a case study from Northumbria Healthcare NHS Trust where they used their PROMs data to identify better outcomes associated with a particular knee replacement implant. They were able to significantly improve outcomes by changing to this implant.
4) It also discusses a study they did which found that preserving the infrapatella fat pad during knee replacements led to
Curative lung radiotherapy has historically been hampered by inadequate imaging techniques. Conventional CT provides poor information regarding tumour shape, size and motion throughout the patient’s breathing cycle. Consequently lung radiotherapy techniques have been characterised by excessively large targets to ensure the actual tumour receives the intended treatment.
One example of how Clinical Cancer Registry level data can review practice va...Cancer Institute NSW
We examined the possible utility of using Cancer Institute NSW Clinical Cancer Registry data by examining one contentious issue in radiation oncology as an example. Increasing evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early, node-negative breast cancer.
Presentation delivered at the Faculty of Medical Leadership & Management: Cambridge QI Conference 28.11.15. This medical student lead quality improvement project was supervised by Mr Adnan Saithna, Consultant Knee and Shoulder Surgeon, Southport and Ormskirk Hospitals NHS Trust. The project demonstrated a significant improvement in quality after delivering an evidence-based educational and training package to radiographers.
Curative lung radiotherapy has historically been hampered by inadequate imaging techniques. Conventional CT provides poor information regarding tumour shape, size and motion throughout the patient’s breathing cycle. Consequently lung radiotherapy techniques have been characterised by excessively large targets to ensure the actual tumour receives the intended treatment.
One example of how Clinical Cancer Registry level data can review practice va...Cancer Institute NSW
We examined the possible utility of using Cancer Institute NSW Clinical Cancer Registry data by examining one contentious issue in radiation oncology as an example. Increasing evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early, node-negative breast cancer.
Presentation delivered at the Faculty of Medical Leadership & Management: Cambridge QI Conference 28.11.15. This medical student lead quality improvement project was supervised by Mr Adnan Saithna, Consultant Knee and Shoulder Surgeon, Southport and Ormskirk Hospitals NHS Trust. The project demonstrated a significant improvement in quality after delivering an evidence-based educational and training package to radiographers.
Introducing VESPIR: a new open-source software to investigate CT ventilation ...Cancer Institute NSW
Computed tomography ventilation imaging (CTVI) is an exciting new functional lung imaging modality enabling functionally adaptive lung cancer radiotherapy treatments. In 2015, this became clinical reality with the first patient treatment performed in the US. Unfortunately the development of new CTVI workflows in the clinic can be challenging, due to the requisite advanced four-dimensional (4D) image processing. To overcome this, we have developed VESPIR (VEntilation via Scripted Pulmonary Image Registration), a user-friendly software toolkit to help streamline the end-to-end validation of CTVI workflows in the clinic.
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
Expediting Colonoscopy for Patients with + Faecal Occult Blood Test in a Publ...Cancer Institute NSW
Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.
The Lung Cancer Demonstration Project: Implementation and evaluation of a lun...Cancer Institute NSW
The Royal Prince Alfred Hospital lung MDT was established in 1984. Historically, information about MDT decision making was captured as free text in the electronic medical record, including patient investigation and staging. This information was accessible to clinical staff; however, it was not routinely distributed to GPs involved in the patient's care. We identified a potential gap in the current reporting and communication processes.
Introducing VESPIR: a new open-source software to investigate CT ventilation ...Cancer Institute NSW
Computed tomography ventilation imaging (CTVI) is an exciting new functional lung imaging modality enabling functionally adaptive lung cancer radiotherapy treatments. In 2015, this became clinical reality with the first patient treatment performed in the US. Unfortunately the development of new CTVI workflows in the clinic can be challenging, due to the requisite advanced four-dimensional (4D) image processing. To overcome this, we have developed VESPIR (VEntilation via Scripted Pulmonary Image Registration), a user-friendly software toolkit to help streamline the end-to-end validation of CTVI workflows in the clinic.
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
Expediting Colonoscopy for Patients with + Faecal Occult Blood Test in a Publ...Cancer Institute NSW
Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.
The Lung Cancer Demonstration Project: Implementation and evaluation of a lun...Cancer Institute NSW
The Royal Prince Alfred Hospital lung MDT was established in 1984. Historically, information about MDT decision making was captured as free text in the electronic medical record, including patient investigation and staging. This information was accessible to clinical staff; however, it was not routinely distributed to GPs involved in the patient's care. We identified a potential gap in the current reporting and communication processes.
Learn more about Patient Reported Outcome Measures (PROMS) and how this information supports better care.
This presentation was delivered at EHI Live 2013.
Prof Devlin discusses the rationale for the PROMs programme and provides an overview of the various uses of the EQ-5D in England—for example by NICE in health technology assessment, in population surveys and in the English NHS PROMS program. The presentation also reviews how EQ-5D data are collected, analysed and used in the UK to inform decisions by health care providers, payers and patients.
This is the HSCIC's draft five-year strategy. A consultation is now open, until February 27th, to gather your feedback. Please have your say and help to shape our future. http://bit.ly/16o8zfk
The specialized industry of collecting electronic patient-reported outcomes is increasing linearly, in part because global government regulators want to hear directly from the patient, and because the acceleration and availability of electronic collection (vs. paper collection) improves data quality and efficiencies for data analysis and trial management. This document will review the ePRO market, and outline the five ePRO methods what successfully support the collection of patient-reported data
Here is my presentation for an exciting event at King's Fund 26 MARCH 2015
This is the published programme for the day
Session one: Opening plenary
9.45am: Welcome and introduction
Dr Johnny Marshall, Director of Policy, NHS Confederation
9.55am: Transforming community health care services in London
Caroline Alexander, Chief Nurse, NHS England, London Region
10.15am: Panel session: The challenges and opportunities for improving and developing community services
Caroline Alexander, Chief Nurse, NHS England, London Region
Matthew Winn, Chief Executive, Cambridge Community Services NHS Trust and Chair, NHS Confederation Community Health Services Forum
Dr Crystal Oldman, Chief Executive, Queen's Nursing Institute
further panelists to be confirmed
10.55am: Questions and discussion
11.10am: Refreshment break and networking
Session two: What does good look like?
11.40am: Welcome and introduction
Catherine Foot, Assistant Director of Policy, The King’s Fund
11.45am: Regulating community health services
Ellen Armistead, Deputy Chief Inspector, Care Quality Commission
12.05pm: How and what should we measure to ensure quality?
Christina Walters, Programme Director, Community Indicators Programme
Andrew Barber, Technical Consultant, Community Indicators, Outcome Measures and Payment System Development Programme
12.25pm: Questions and discussion
12.40pm: Buffet lunch, networking and exhibition
Session three: Good practice breakout sessions
Sessions will run from 1.40-2.55pm and delegates will have the choice of:
A: Quality assurance: how are you using data locally to measure for quality?
1.40pm: Welcome and introduction
1.45pm: The use of PROMs (Patient Reported Outcome Measures) in a community setting
Iain Cockley-Adams, Service Improvement Manager, Gloucestershire Care Services NHS Trust
2.05pm: Over2You Quality Volunteers
Ruby Smith, Head of Personalisation, South Yorkshire Housing Association
2.25pm: PROMS in Practice: The Collection Analysis and Reporting of quality of life indicator EQ5D in rehabilitation services in Cambridgeshire Community Services
Andrew Bateman PhD, Physiotherapist and Service Manager, Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust
2.45pm: Questions and discussion
B: Working with patients and communities: what are you doing to involve patients and their families and carers and to make your services more person-centred?
C: Partnerships and relationships with other parts of the system: how are you building effective local partnerships across health and social care?
2.55pm: Refreshment break and networking
Session four: Good practice breakout sessions
Sessions will run from 3.15-4.30pm and delegates will have the choice of:
D: Supporting and encouraging team working: what are you doing to support team working?
E: Working with patients and communities: what are you doing to involve patie
Patient activation: New insights into the role of patients in self-managementMS Trust
This presentation by Helen Gilburt, Fellow at The King's Fund, looks at why some people are active at managing their health while others are quite passive, and how levels of patient activation impact on health outcomes.
It was presented at the MS Trust Annual Conference in November 2014.
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
Improving the Outcomes That Matter Most to PatientsHealth Catalyst
Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) have been used in healthcare since the 1970s. But the industry hasn’t had meaningful, consistent PROs and PROMs definitions until ICHOM developed one. ICHOM, a pioneer in outcomes measurement and improvement, demonstrates that healthcare organizations focused on improving patient outcomes that patients actually care about are the ones most likely to transform healthcare.
PROs and PROMs complement clinical indicators in understanding the quality of healthcare a team is delivering. For example, an improvement program for prostate cancer patients that only focuses on improving blood loss or length of stay in the hospital completely misses a patient’s biggest fears: will they need to wear pads for the rest of their life? Will their relationship with their partner be the same as it was?
By focusing on outcomes that matter most to patients, health systems will be more successful at improving outcomes. ICHOM describes five strategies for getting started with PROs and PROMs:
Find the Believers (Identify Clinician Champions)
Organize a Cross-Functional Team (with Appropriate Governance)
Invest Time and Resources
Celebrate Progress Along the Way
Use Early Successes to Scale and Spread
Why Patient-Reported Outcomes Are the Future of HealthcareHealth Catalyst
Patient-reported outcomes (PROs), defined as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else,” are the future of healthcare. In addition to helping people like 80-year-old-Ruth continue to live interpedently, PROs—interchangeable with the term patient-generated health data (PGHD)—have several benefits:
Effectively supplement existing clinical data, filling in gaps in information and providing a more comprehensive picture of ongoing patient health.
Provide important information about how patients are doing between medical visits.
Gather information on an ongoing basis—rather than just one point in time—and provide information relevant to preventive and chronic care management.
The new technologies that enable PROs and PGHD (e.g., sensors that detect whether Ruth takes food out of her refrigerator on a regular basis), generate important data outside of patients’ traditional care environments, sharing it with care teams to expand the depth, breadth, and continuity of information available to improve healthcare and outcomes.
Maxine Powers, National Improvement Advisor at Department of Health, addresses Why QIPP and why now?, Programme design, National Work stream plans for safety and the role and contribution of AHPs. COT Annual Conference 2010 (22-25 June 2010)
Adult survivorship: from concept to innovationNHS Improvement
The National Cancer Survivorship Initiative (NCSI) is a partnership between the Department of Health, Macmillan Cancer Support and NHS Improvement. As part of this initiative, NHS Improvement is testing approaches to care and support that ensures that we are moving to a position of not only supporting recovery from their disease, but also their future health and wellbeing through sustaining that recovery. During the last few years a proof of principle has been established which if transferable from the test sites to other organisations will begin the process of spread across the NHS and provide national risk stratified effective pathways for breast, colorectal and prostate cancers.
Aldo Rolfo, National Clinical Development Manager, Genesis Cancer Care, Austr...GenesisCareUK
A program that seeks to redefine best practice across the drivers of the GenesisCare business (Quality, Access and Efficiency) in order to deliver on their vision of “Innovating Healthcare. Transforming Lives.”
This month's community call is part two in a series on Clinical Transformation. The presentations will highlight how Clinical Transformation affects outcomes AND the bottom-line of health care organizations. The presentation will provide a proof point on how Clinical Transformation has a direct Return on Investment (ROI) for both the patient and the provider organization.
This topic is both clinical and administrative in nature and will likely be useful to physicians, nurses and others interested in outcomes, as well as health care CIOs, CFOs and administrators.
Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.
What: Clinical Transformation (Part II)
- Clinical Transformation
- a Blueprint
- in Practice
- Transformation Working Group Update
- Review of status
- Framework for Planning
- Discussion
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month
When: March 26, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording available here: http://medsphere.org/blogs/events/2009/03/26/community-call-march-2009
An opportunity to hear how service redesign positively impacts on the patient experience and improves outcomes for both the patient and NHSScotland. Showcasing examples of changes to pathways of care in orthopaedics and community support for people with complex and chronic conditions.
What a difference a day makes
Small improvements at each step of the end to end pathway, as little as one hour or one day, support users to deliver effective MDTs, redesign outpatient clinics and improve the patient experience and outcomes
(Jan 2011).
Mr James Downie, CEO, presented on the topic 'Moving towards value based funding' at the 2017 Activity-Based Funding Conference, hosted by the Health Service Executive, Ireland on 11 May 2017.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Making the most of your PROM data, pop up uni, 10am, 2 september 2015
1. Making the most of your
PROM data
Jo Partington, Rafael Goriwoda (NHS England)
and Tom Partridge (Northumbria Healthcare NHS Trust)
Pop Up University 5
10am; 2nd September 2015
2. Appleby and Devlin 2010
“The first health system
internationally to measure what
it produces in terms of health.”
3. Content
I – Backgroundto the national PROMs programme
What are PROMs?
How does the national PROMs programme relate to wider NHS policy.
II – Variationin outcomes (nationally)
How PROMs data canbe usedto identify goodperformanceorareas forconcern.
III – So what?
How provider trusts caninvestigate theirPROMs data to improve outcomes.
Northumbria case study.
4. What are PROMs?
National data collections
Since 2009, patients undergoing
Hip Replacement,Knee
Replacement,VaricoseVeinand
GroinHernia surgery are asked
to participate
Objective
To measure and improve the
quality of treatment and
care patients receive,in
order to positively affect
outcomes forpatients.
Definition
Measures of the outcomes of
treatment,whichare based
upon asking patients to report
ontheir ownhealth
outcomes.
Scope
In2013/14: 139,774 patients
gave feedback ontheir health
state before andafter surgery.
255,000
Episodes
139,000
complete
answers
Participation
• 3/4 patients fill out a
questionnaire before surgery.
• Of these, 3/4 respondto the
post-operative questionnaire.
55% of patients
gave pre- and post-op
feedback in13/14
Non responders
5. Wider policy context
• NHS Outcomes Framework: 3.1
• NHS Mandate
• NHS Standard contract
• Five Year Forward View
• Personalised Health and Care 2020 : Using
Data and Technology to Transform
Outcomes for Patients and Citizens –
National Information Boardstrategy
• Best practice tariff
6. New developments in PROMs
• Cancers (breast, prostate,bowel, bladder,
non-Hodgkin’s lymphoma, womb, ovary and
cervix): the pilot PROM reporton living with
and beyond bladder cancer will be published
shortly. Prostate Cancer UK are the first charity
to solely fund a UK-wide PROM project.
• Cardiovascular revascularisation:pilot data
collected, linkage with NICOR on-going and
then the analysis and final reportdue.
• Renal replacement: Being developed at the
UKRR; will look at the link between Patient
Activation Measures, Patient Experience and
PROMs.
• Major Trauma – Pilot sites already collecting
data – some investment from the Medical
Directorate
• Dementia: DEMQoL developmentthrough
National Institute for Health Research (NIHR)
• Long-term conditions: As for dementia,
development through NIHR.
PROMs pilots beyondthe national programme
• Publication on MyNHS and NHS Choices
• Upcoming “Insight Strategy Short Guide
to PROMs”
• Work with ISIS Outcomes at the
University of Oxford to support the
development of electronic PROMs
Making better use of what we have
7. My problemsare
much better after
surgery.
My problemsarea
littlebetter or much
the same.
My problemsare
worsethan before.
19 out of 20
patientssay
theirproblems
were much
betterfollowing
hipreplacement
18 out of 20
patientssay their
problemswere
much better
followingknee
replacement
1 out of 20
patientssay
theirproblems
were worse
followinghip
replacement
1 out of 13
patientssay their
problemswere
worse following
knee
replacement
17 out of 20
patientssay their
problemswere
much better
followingvaricose
veinsurgery
10 out of 20
patientssay their
problemswere
much better
followinggroin
herniarepair
3 out of 20
patientssay their
problemswere
worse following
varicose vein
surgery
3 out of 20
patientssay their
problemswere
worse following
groin hernia
Hip Knee Varicose Vein Groin hernia
What PROMs tells us: most patients report successful
procedures
8. -15
-10
-5
0
5
10
15
20
25
0 100 200 300 400 500 600 700 800 900
AdjustedHealthGain
Number of Modelled Records (Trust Size)
95% control limits
99.8%control limits
England
All
Trust ATrust B
Trust C
Trust D
Using PROMs to identify variation across provider
trusts
Organisation
Name
Significa
nce
Interpretation
Trust A Upper
99.8%
Amongthe best
outcomes
Trust B Averageoutcomes
Trust C Lower
95%
Belowaverage
outcomes
Trust D Lower
99.8%
Amongthe worst
outcomes
TrustD would notreceive
the BPT for hip andknee
replacements
The chanceof
patientsata trust
havingaverage
outcomes belowthis
level by random
chanceis1 in 1000.
Taking into account
each trust’s case-
mix!
9. Differences that matter to patients: results at a
repeat outlier
Domain Trust score National
Patients sayingresults were fair at best 18.9% 11.2%
Patients sayingproblems now worse 6.6% 4.2%
Patients reachingexcellent score (42+),Hip 26% 51%
Patients reachingexcellent score (42+),Knee 18% 30%
Patient withextreme difficulty kneelingdownand getting up again
afterwards,Knee
63.7% 53.5%
.. Dressingthemselves,Hip 23.9% 12.2%
Patients havinghad urinary problems 15.9% 11.5%
… problems with the woundhealing. 15.7% 11.3%
… anallergy or adverse reactionto drug. 13.4% 10.3%
… problems with their wound bleeding. 8.7% 6.4%
10. So What? Putting PROMs into practice
• PROMs is used in a variety of ways:
• Audit & Effectiveness Committees – local
• Quality Boards - local
• Best Practice Tariff
• Care Quality Commission “Intelligent Monitoring”
• “Beyond Compliance”
• “Getting It Right First Time”
• Examples from HSCIC benefitrealisation study:
• Enhanced recovery pathways implemented; PROMs used to evaluate success of
components
• Revised pain management regimes => earlier mobilisation; improved rehab ++ = better
outcomes
• Analysis of themes where people struggled post-operatively, and exercises included in
post-op appointments
• Better wound management protocols
• Altered mode of knee surgery treatment
11. QUALITY IMPROVEMENT USING
PROMS IN TOTAL KNEE
REPLACEMENT
Presenter: Mr T Partridge MBBS, MRCS
Northumbria Healthcare NHS Foundation Trust
Co-authors: Muller S, Emmerson KP, Carluke I, Partington PF, Reed
MR
12. Large provider
Vast geography
4 main sites
Over 2000 hip and knee
replacements/year (3rd
largest nationally)
13. INTRODUCTION
PROMs introduced in 2009
Evaluate quality of care
Drive patient choice
Empowercommissioners
Total Knee Replacement
Pre and 6 month post procedure OKS and EQ5D
Remuneration on compliance and outcome
14. QUALITY IMPROVEMENT USING PROMS
IMPROVING PROMS IN TOTAL KNEE
REPLACEMENT BY CHANGING IMPLANT: A
QUALITY IMPROVEMENT PROJECT
DOES PRESERVATION OF THE INFRAPATELLA
FAT PAD IMPROVE PROMS IN TOTAL KNEE
REPLACEMENT?
15. PROMS – TKR OKS adjusted
funnel plot
Volume of modeled records
OKSimprovementscore
17. METHODOLOGY
• Mass move to ‘best’ TKR brand
– 6 month transition period
– Re-training
• Retrospective cohort study using PROMs database
– April 2009 to March 2014 Northumbria Healthcare TKR
– Incomplete records/transition period excluded
18. PROMs improvement scores pre and post
implant change
Implant Q1 SCORE EQ5D GAIN OKS GAIN
Pre-change
Brand A
(581)
Brand B
(246)
20.4
(19.8-21.0)
20.7
(19.7-21.6)
0.256
(0.230-0.281)
0.265
(0.225-0.305)
13.7
(13.1-14.6)
14.2
(12.9-15.4)
Post-change
Brand C
(796)
20.5
(19.9-21.0)
p=(0.866)
0.288
(0.264-0.312)
(p=0.07)
16.6
(15.6-17.1)
(p=0.007)
19. PROMS – TKR OKS adjusted
funnel plot 2013-14
Volume of modeled records
OKSimprovementscore
20. STUDY CONCLUSIONS
• Significant improvement in TKR outcome by change of TKR brand
• Evidence based practice - highlighted by PROMs/NJR project
• Showcase national PROMs agenda
21. DOES PRESERVATION OF THE
INFRAPATELLA FAT PAD IMPROVE
PROMS IN TOTAL KNEE REPLACEMENT
22. THE FATPAD IN TKR
Removal of the infrapatella fat pad remains controversial
blood supply to the patella tendon
biomechanics of the knee
inflammatory modulator
VS
improved access
visualisation
23. AIM AND METHODOLOGY
To determine if the default removal of the infrapatella fat pad
affects patient outcome in TKR.
Retrospective cohort study using PROMs database
OKS and EQ5D pre-operatively and at 6 months.
Correlated with consultant default practice of
excising
partially removing
preserving the infrapatella fat pad.
24. PROMs improvement scores per default
infrapatella fatpad practice
NUMBER OKS CHANGE EQ5D CHANGE
EXCISED 297 15.0 (13.8-16.3) 0.262
PARTIAL 178 16.6 (15.3-18.0) 0.295
PRESERVED 169 17.3 (15.7-18.9) 0.327
25. Mean Change in OKS (95% CI) comparing
individual consultant fat pad default practice
8
10
12
14
16
18
20
22
MeanChangeinOKS(95%CI)
PRESERVER PARTIAL EXCISER
27. STUDY CONCLUSION
Patients report better outcomes if their surgeons default to
preserving the infrapatella fat pad
Pain is reported difference
In the absence of a randomised trial surgeons should consider fat
pad preservation
28. PROMS – TKR OKS adjusted
funnel plot 2013-14
Volume of modeled records
OKSimprovementscore
29. PROMS
• Show case PROMs agenda
• Local projects vs national projects
• Publication of trust PROMs and the possibility of performance based
remuneration makes self-evaluation of practice ever more important.
• Excellent opportunity for quality improvement