A PROM collection system for service evaluation in ... web based PRO… · A web based PROM collection system for ... routine outcome measurement by allied health professionals in

Jonathan Field DC PgD MSc FRCC (Pain)Chiropractor

Chair, pain faculty Royal College of ChiropractorsDave Newell BSc PhD FRCC

Research Director AECC

A web based PROM collection system for monitoring and service evaluation in musculoskeletal patients: Care Response

www.care-response.com

Patient Reported Outcome Measures (PROMS)

Help improve patients care:• an aid to informed decision making • supports communication and shared

decision making• flags areas for possibly improving clinical

practice



Help improve patients care:• an aid to informed decision making • supports communication and shared

decision making• flags areas for improving clinical practice



Help improve patients careHelp develop services:• informs patients choice of a provider• informs referrers of clinics results• demonstrate outcomes to service

purchasers



Help improve patients careHelp develop services Help develop clinical evidence:• contribute to outcome research


Equality and Excellence; liberating the NHS (2010) & NHS Outcomes Framework (2012)

• The improvement of healthcare outcomes for all will be the primary purpose of the NHS.

• Patients and their choice will be at the heart of everything the NHS does

• Use of PROMs will be extended across the NHS wherever practicable


Research and our experience indicates there are considerable barriers to implementing routine collection of PROMs data using traditional paper based processes

Duncan, E.A. & Murray, J., 2012. The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC health services research, 12(1), pp.96–9.


Barriers to collecting patients assessments include:

• Practical difficulties in asking patients to complete forms in a busy or short handed practice

• Incomplete forms (missing responses) • Time for clinicians to analyse them• Explaining meaning of results to patients• Collating results


To remove barriers to collecting patient assessment we wanted to take as much of the work away from clinics & HCP’s as possible.

Using technology to -• give patients choice in how/where to complete PROMs

• screen for incomplete forms• score assessments• present results immediately as simple graphs• collate results & enable anonymised comparison of services for audit


Pragmatic collection of patients responses

Online

Paper forms

iPad & other Tablets

Computer terminals or laptops











User experience:

• 79% of clinicians satisfied using the system• 84% say they are likely to continue to use it

• 62% discuss results with patients in clinic

www.care-response.comAdditional Stakeholders

Data has been used to inform stakeholders at other levels in addition to patients and clinicians

•Engaging and informing the profession•Informing local CCG commissioning•Clinical research community

We have explored large data sets generated by this system to answer particular clinical research questions

1.Identifying patient subgroups based on outcomes2.Clinometric analysis of outcome measures3.Exploring utility of screening tools (STarT Back)4.Service provision research including cost evaluation5.Comparing patient populations (NHS v Private)



Large data sets have enabled detailed descriptions of the patients journey going though care for MSK conditions.

The data here represents a cohort of 3339 patients over the course of 12 months


1.NEWELL D and FIELD J (2007). Who will get better? Predicting clinical outcomes in chiropractic practice. Clinical Chiropractic 10, 179-186 2.NEWELL D and BOLTON JE (2010) Responsiveness of the Bournemouth Questionnaire in determining minimal clinically important change in subgroups of low back pain patient. Spine 35(19):1801-6

3.FIELD J and NEWELL D (2010) Preliminary study into the components of the fear avoidance model of LBP: Change after an initial chiropractic visit and influence on outcome. Chiropractic and Osteopathy 18:21

4.FIELD J, NEWELL D (2012) Relationship between STarT Back Screening Tool and Prognosis for Low Back Pain patients receiving Spinal Manipulative Therapy. Chiropractic and Manual therapies.20:17

5.NEWELL D, FIELD J and VISNES N (2014) Prognostic accuracy of clinicians for back, neck and shoulder patients in routine practice. Chiropractic and Manual Therapies 21:42

6.PERNILLE IRGENS, LISE R LOTHE, OLE CHRISTIAN KVAMMEN, JONATHAN FIELD AND DAVID NEWELL (2014) The psychometric profile of chiropractic patients in Norway and England: using and comparing the generic versions of the STarT Back 5-item screening tool and the Bournemouth Questionnaire. Chiropractic & Manual Therapies, 21:41

7.FIELD J, McKERNAN P and NEWELL D (2014) Comparative service evaluation of patients presenting for chiropractic/osteopathic care privately with those referred for care via the NHS: Back2Health partnership: Emerging Evidence, College of Chiropractors, London

8.DIMENT E, NEWELL D and BOLTON J (2014) Collecting PROMs; Does it have to be a pain in the neck? Survey of clinicians’ perceptions of using an E-PROMs data collection tool. ECU convention, Dublin

9.FIELD J and NEWELL D (2014) An Any Qualified Provider (AQP) based back and neck pain service evaluation provided by chiropractors in the UK: A comparison of self-referred and NHS referred patients BMC Health Services Research (submitted)

10.NEWELL D, FIELD J AND POLLARD D (2014) Using the STarT back tool: Does timing of stratification matter? Manual Therapies http://www.scieNEWELL D and FIELD J (2007). Who will get better? Predicting clinical outcomes in chiropractic practice. Clinical Chiropractic 10, 179-186

11.NEWELL D and BOLTON JE (2010) Responsiveness of the Bournemouth Questionnaire in determining minimal clinically important change in subgroups of low back pain patient. Spine 35(19):1801-6

12.FIELD J and NEWELL D (2010) Preliminary study into the components of the fear avoidance model of LBP: Change after an initial chiropractic visit and influence on outcome. Chiropractic and Osteopathy 18:21

13.FIELD J, NEWELL D (2012) Relationship between STarT Back Screening Tool and Prognosis for Low Back Pain patients receiving Spinal Manipulative Therapy. Chiropractic and Manual therapies.20:17

14.NEWELL D, FIELD J and VISNES N (2014) Prognostic accuracy of clinicians for back, neck and shoulder patients in routine practice. Chiropractic and Manual Therapies 21:42

15.PERNILLE IRGENS, LISE R LOTHE, OLE CHRISTIAN KVAMMEN, JONATHAN FIELD AND DAVID NEWELL (2014) The psychometric profile of chiropractic patients in Norway and England: using and comparing the generic versions of the STarT Back 5-item screening tool and the Bournemouth Questionnaire. Chiropractic & Manual Therapies, 21:41

16.FIELD J, McKERNAN P and NEWELL D (2014) Comparative service evaluation of patients presenting for chiropractic/osteopathic care privately with those referred for care via the NHS: Back2Health partnership: Emerging Evidence, College of Chiropractors, London

17.DIMENT E, NEWELL D and BOLTON J (2014) Collecting PROMs; Does it have to be a pain in the neck? Survey of clinicians’ perceptions of using an E-PROMs data collection tool. ECU convention, Dublin

18.FIELD J and NEWELL D (2014) An Any Qualified Provider (AQP) based back and neck pain service evaluation provided by chiropractors in the UK: A comparison of self-referred and NHS referred patients BMC Health Services Research (submitted)

19.NEWELL D, FIELD J AND POLLARD D (2014) Using the STarT back tool: Does timing of stratification matter? Manual Therapies http://www.sciencedirect.com/science/article/pii/S1356689X14001441

Publications based on CR Data


150 practices in the UK

33,000 sets of data

Care Response is cloud based ‐ there is no software to install

It is free for clinics to use.

Documents

A PROM collection system for service evaluation in ... web based PRO… · A web based PROM collection system for ... routine outcome measurement by allied health professionals in