This week’s hot topic has been about how do PROMs (patient reported outcome measures) become a quality measurement of NHS services AND THEN AGAIN how this translates into informed decision-making?
The PROM is a questionnaire filled in by a patient before surgery/during a consultation. The patient is then a few months later is sent by post, a follow-up questionnaire. Since 2009 all providers of NHS funded knee replacements, hip replacements, groin hernia surgery, or varicose vein surgery have collected these data from patients. These give a ‘before and after’ snapshot of patient response.
With surveys in general, the audience is self-selecting, self-adminstrated and victim of poor response rates. However the PROMs has proved a overall response rate of 60% and 69% for preoperative and post-operative questionnaires respectively. better measurement of health improvement on a day-to-day basis
The HSJ evidenced in an article last month the potential usefulness of PROM information. Their article suggests 80,000 operations of the four types covered by the PROMs data resulted in no change or a deterioration in a patient’s condition. These operations are estimated to cost the NHS £180m overall.
Mark Goldman , writes for the same issue about another qualitative measure – patient satisfaction,
“Customer satisfaction is equally flawed. Some of the most loved clinicians, as judged by their patients, may not return the best clinical outcomes. Attentive and caring clinical staff may receive the largest box of Quality Street from the family of the patient who had the most complications.”
Patient surveys for outcomes OR quality (satisfaction of process) OR quality of outcomes will be victim of qualitative data variance. Though these will be void of scientific medical value in many ways – they go a long way to improving a holistic stance towards how the NHS treats and engages people – not just patients, by using more information than just mortality statistics.
The BMJ reports this week that the momentum behind PROMs is growing and that this method would go beyond the four surgical areas to other long term conditions like diabetes.
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Hi Emma, thanks for the mention and great to discuss the issue. Just wanted to point out that PROMs are very different to patient satisfaction that I think Mark is discussing.
They are much more like an objective clinical outcome than patient experience or satisfaction, which are more about process, seem more subjective, and are subject to rewarding those who are attentive and caring rather than produce good outcomes.
Hi Dave, thanks for reading and highlighting this issue. I have hopefully addressed this error and corrected the attribution accordingly. I wanted to talk about the NHS’s use of qualitative data and the ongoing confusion between process and outcome measures!