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
Paul Bristow, BKPA, and Karen Thomas, UKRR gave a presentation at BRS2017: Embedding patient reported experience into future QI - 1st National PREM Pilot Survey 2016
Paul Bristow, BKPA, and Karen Thomas, UKRR gave a presentation at BRS2017: Embedding patient reported experience into future QI - 1st National PREM Pilot Survey 2016
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
Discharge Planning: Compliance with CMS Hospital and CAH CoPs 2021Conference Panel
This program will cover the new changes to the discharge planning standards that became effective November 2019 and published in the February 21, 2020 manual. It is anticipated CMS will publish revised interpretive guidelines and survey procedures to match the new regulations in 2021.
Presentation from NHS Improvement endoscopy workshop held at Ambassadors Hotel, London on 29 January 2013
http://www.improvement.nhs.uk/diagnostics/EndoscopyImprovement/Events.aspx
Improving endoscopy admin systems - a trial of direct booking
Wendy Mitchell
James Paget University Hospitals NHS Foundation Trust
The Importance of measuring outcomes, including Patient Reported Outcome Measures (PROMS)
BAOT Lifelong Learning Event
10 November 2010
Dr Alison Laver-Fawcett
Head of Programme, BHSC(Hons) Occupational Therapy
York St John University
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
Discharge Planning: Compliance with CMS Hospital and CAH CoPs 2021Conference Panel
This program will cover the new changes to the discharge planning standards that became effective November 2019 and published in the February 21, 2020 manual. It is anticipated CMS will publish revised interpretive guidelines and survey procedures to match the new regulations in 2021.
Presentation from NHS Improvement endoscopy workshop held at Ambassadors Hotel, London on 29 January 2013
http://www.improvement.nhs.uk/diagnostics/EndoscopyImprovement/Events.aspx
Improving endoscopy admin systems - a trial of direct booking
Wendy Mitchell
James Paget University Hospitals NHS Foundation Trust
The Importance of measuring outcomes, including Patient Reported Outcome Measures (PROMS)
BAOT Lifelong Learning Event
10 November 2010
Dr Alison Laver-Fawcett
Head of Programme, BHSC(Hons) Occupational Therapy
York St John University
Sir Muir Gray, Chief Knowledge Officer, NHS intoduces the NHS Atlas of Variation, to show show the NHS are maximising values for populations and individuals.
The revised OECD Health Systems Performance Framework: methodological issues ...Sax Institute
The OECD is a leading organization in the international measurement of health system performance. The OECD Expert Group on Health Care Quality Indicators (HCQI) has recently revised its performance framework, identifying core indicators and highlighting new directions. Although improving, the capacity of countries to deliver more accurate standardized indicators still needs to be fostered. A particular aspect that deserves attention is the design, planning and implementation of public performance reporting. Such activity, strictly interrelated to the capacity of the information infrastructure, also depends from cultural, organizational and political conditions that can be differently present at the international level. The applicability of standardized principles and the evidence of improved outcomes due to public reporting systems is still questioned to a large extent. A first international conference on the topic of hospital performance reporting has been organized in Rome, Italy in 2014, followed by a second event held in Seoul, South Korea, in 2015. In his talk, Fabrizio Carinci will present recent developments of OECD projects, including:
• state of the art in the definition of OECD performance indicators
• challenges emerging from OECD R&D studies
• transferability and use of definitions at sub-national and provider level
• applicability for hospital performance benchmarking and geographical variation
• limitations imposed by the legislation on privacy and data protection
• an overarching vision of “essential levels of health information”
Through practical examples drawn from his direct experience as Member of the Bureau of the HCQI and other relevant Boards, Prof. Fabrizio Carinci will discuss the state of the art, the role played by national governments (including Australia), and potential avenues for mutual collaboration.
Universal Health Coverage Action Framework for the Western Pacific RegionAlbert Domingo
Presentation by Dr Albert Francis Domingo, delivered at the meeting on rehabilitation as part of the continuum of people-centred health care, Seoul (Republic of Korea), 13-15 December 2016.
"When our Patient Experience measures improved, so did our Quality and Safety measures" - Sir Robert Naylor, CEO, University College London Hospitals NHS Trust, Sustainable Health Transformation 2014
Effect of Financial Incentives on Incentivised and Non-Incentivised Clinical Activities: Utilising Primary Care Databases to answer clinical, policy and methodological questions
Measuring and improving the impacts of Health IT on clinical, cost and efficiency outcomes. Presented by Steven Shaha, Center for Policy & Public Administration, UK, at HINZ 2014, 12 November 2014, 12.22pm, Marlborough Room 3
Tutorial on Principles of Health Interoperability, presented at Informatics for Health Conference, Manchester 23 April 2017. Covers SNOMED CT, HL7 and FHIR and why interoperability is hard.
The need and conceptual specification for stringent metadata standards for use in clinical and patient portals.
Full paper is at: http://ebooks.iospress.nl/volumearticle/39408
Slides from presentation at MIE 2015 Madrid
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
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
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
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.
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.
1. Oxford International Health Conference 2015 1
Short Generic Patient-Reported Quality
Measures
Tim Benson
R-Outcomes Ltd
Oxford International Health Conference
27 June 2015
St Hugh’s College Oxford
2. Oxford International Health Conference 2015 2
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.
3. Oxford International Health Conference 2015 3
Health-Related
Quality of Life
Health
Confidence
Patient
Experience
Three aspects of patient
perception
4. Oxford International Health Conference 2015 4
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
5. Oxford International Health Conference 2015 5
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
6. Oxford International Health Conference 2015 6
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
7. Oxford International Health Conference 2015 7
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)
8. Oxford International Health Conference 2015 8
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
9. Oxford International Health Conference 2015 9
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
10. Oxford International Health Conference 2015 10
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
11. Oxford International Health Conference 2015 11
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
12. Oxford International Health Conference 2015 12
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
13. Oxford International Health Conference 2015 13
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
14. Oxford International Health Conference 2015 14
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
15. Oxford International Health Conference 2015 15
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
16. Oxford International Health Conference 2015 16
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
18. Oxford International Health Conference 2015 18
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
19. Oxford International Health Conference 2015 19
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
20. Oxford International Health Conference 2015 20
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
21. Oxford International Health Conference 2015 21
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