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Patient Reported Outcome Measures (PROMs): Speaker News and Updates

Chaired by Prof W Angus Wallace Division of Orthopaedic and Accident Surgery University of Nottingham/Nottingham University Hospitals this conference will open with international and national developments in Patient Reported Outcome Measures (PROMs) and will then focus on PROMs in clinical practice; using case studies of PROMs changing clinical practice alongside expert sessions on subjects such as using PROMs for decision making, to change practice, and auditing and analysis of outlines.  

There will also be national updates on the future of PROMs, a masterclass aimed at beginners to PROMs, an extended interactive session focusing on ePROMs, and another focusing on patient engagement and involvement in PROMs development. 

Chair’s Introduction: PROMS in Clinical Practice
Professor W Angus Wallace
 Division of Orthopaedic and Accident Surgery, University of Nottingham/Nottingham University Hospitals

NHS England Update: Measuring Patient Outcomes & Experience
The results and implications of the National PROMs Consultation
Emma Doyle
 Head of Data Policy Information & Transparency Group, Patients & Information Directorate, NHS England and Sarah Benger Senior Programme Manager (Living With and Beyond Cancer), NHS England. 

  • NHS England Update: bringing together PROMs and PREMs
  • current and future developments

Emma Doyle and Sarah Benger's Full Presentation

In there presentation Emma and Sarah Stated: 

“We need to make sure that outcomes based analysis is embedded across the NHS”

“PROM are incredibly important approaches are being developed in clinical areas such as cancer, long term conditions and are embedded into mental health datasets.”

“In order for outcomes measurements to have an impact people need to be aware of them, they need to credible and people need to know what to do in response. This is absolutely critical people need to know what to do with the data and how to develop.”

“We need to make sure we are really measuring what matter to patient. We need to make sure we don’t forget that all patients are different. It not a one size fits all situation”

“There are big questions marks around Geographical population vs provider vs team vs clinician vs patient and we need to look at how we square these together to ensure we have a positive outcomes measure”

“We need to have outcomes as a core currency of the NHS”

“We need to create an environment where innovation can flourish – to make the NHS the best”

“We need to help people to embed outcomes in the process of continuous quality improvement”

“People need to know how to use outcomes to effect change”

“Using PROMS for measuring long-term quality of life in people living with and beyond cancer is a game changer”

Changing Clinical Practice as a result of PROMS
The development of a new PROM
Professor John Sparrow 
Consultant Opthalmologist & Honorary Professor of Opthalmic Health Services Research & Applied Epidemiology, University Hospitals Bristol NHS Foundation Trust & University of Bristol

Abstract submission:
A UK developed NHS suitable brief patient reported outcome measure: Cat-PROM5

To develop a brief NHS suitable UK relevant cataract surgery patient reported outcome measure capable of reliably measuring visual difficulty from cataract and its relief from surgery.  

A psychometrically robust cataract PROM, Cat-PROM5, has been developed Across 3 data collection and analysis cycles. With only 5 items the instrument is sufficiently brief to make implementation into routine NHS cataract care feasible. In this NIHR funded work, items were harvested from 2 existing UK developed cataract visual difficulty and quality of life questionnaires. A rigorous item reduction approach has delivered a brief questionnaire with performance at least as good as existing longer best of class instruments. 

822 cataract patients from 4 UK cataract surgical centres provided 1266 questionnaire completions. 3 cycles of evaluation resulted in a definitive item set of just 5 unidimensional items which delivered excellent performance in accordance with the requirements of the Rasch model: no threshold disordering, no misfitting items, Rasch based reliability 0.90, person separation 2.98, Cronbach’s alpha 0.89, good targeting of questions to cataract patients with a preoperative item mean +0.01 logits for people with two cataracts and -0.41 logits for people with one cataract, absence of significant floor or ceiling effects, minor deviations of item invariance, and confirmed unidimensionality by PCA of Rasch residuals. The test re-test repeatability intra-class correlation coefficient was 0.89 with excellent responsiveness to surgery, the standardised effect size or Cohen’s d being 1.45SD (>0.8 considered large). 

A robust short NHS suitable cataract surgery patient reported outcome measure has been developed. 

Challenges and issues:
The research team is in discussion with electronic medical record (EMR) system developers with a view to implementation into widely used ophthalmology EMRs. 

Future plans:
Rasch calibration values are provided for future Cat-PROM5 users to facilitate easy implementation. 

Power of PROMs Data to Support Commissioning of Varicose Vein Procedures
Valerie Corris
 Senior Health Information Analyst, North East Quality Observatory Service (NEQOS)

Full PowerPoint presentation.

Abstract submission:
Power of PROMs Data to Support Commissioning of Varicose Vein Procedures

Objective: The aim of this project was to evaluate the utility of PROMs data to support commissioning and compliance with NICE guidance for improving quality of care.

HES analysis provided:
•    frequency of different interventions
•    severity of venous disease at time of intervention (e.g. presence of ulcer)
•    frequency of unilateral vs. bilateral procedures 
•    redo rates within 12-months  

PROMs analysis included assessment of the completeness of data.

There is wide variation in types of interventions and provider level detail on case-mix is needed to support commissioners.

Published PROMs data reports only 40% participation nationally with wide variation at provider level.  Less than 20% of activity has health gain data and is reported for less than 80% of providers.  Outcomes for the different procedure types are not routinely published. 

Published PROMs data has limited value for commissioners in terms of coverage and only pooled outcomes data for all procedures is routinely reported.

Challenges and issues:
Improving PROMs participation is essential and needs engagement from providers.

PROMs data always needs to be viewed in the perspective of clinical quality indicators available through other data sources (e.g. HES)

Future events of interest: 

Measuring, Understanding and Acting on Patient Experience Insight
Friday 24 March 
De Vere West One Conference Centre, London

Setting up and running Virtual Clinics
Friday 28 April 
De Vere West One Conference Centre, London

7 December 2016


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