PROMs Martin Orton – NHS Information Centre

Overview

• PROMs Overview• IC’s central role in implementation

– Matching & linking to HES & NJR– Applying the scoring algorithms– Providing the data for analysis

• Publication and data availability– Publications of information and indicators– Extract service for the data

• The likely uses of PROMs

PROMs

• PROMs are a means of assessing effectiveness of care from the patient’s perspective:

– Effectiveness of care. This means understanding success rates from different treatments for different conditions. Assessing this will include clinical measures such as mortality or survival rates and measures of clinical improvement. Just as important is the effectiveness of care from the patient’s own perspective which will be measured through patient-reported outcomes measures (PROMs)…[1]

• [1] High Quality Care for All: NHS Next Stage Review Final Report. Department of Health. June 2008. Chapter 4.

The PROMs programmeBuilding the evidence base: electives

4. Implement 5. Evaluate2. Pilot1. Identify 3. Review

Literature review(LSHTM 2005)

Pilot study(LSHTM 2007)

Procurement & guidance

(DH)

Cost Benefit Analysis To follow…

Which areas?

Which measures?

Assess the evidence base

How to administer?

Questionnaire design?

Sample sizes?

Statistical power?

Feasible?

Cost-effective?

Acceptable?

How to implement?

How to support implementation?

Guidance?

What works well?

What hasn’t worked?

Where should changes be made?

National Implementation

5

Procedure Condition-specific Generic

Unilateral Hip Replacement Oxford Hip Score EQ-5D*

Unilateral Knee Replacement

Oxford Knee Score EQ-5D*

Groin Hernia Surgery None EQ-5D*

Varicose Vein Surgery Aberdeen Varicose Vein Questionnaire

EQ-5D*

*: EQ-5DTM is a trademark of the EuroQol Group (www.euroqol.org)

Robust tool for health economic analysis, and

comparison across procedures;

Recommended by NICE

More sensitive tool for intra-procedure

comparisons; often more familiar to clinicians – e.g.

OHS / OKS

PROMs questionnaires combine 2 types of measures to maximise

impact of collected data

PROMs contractual model

Aggregated data

PROMs “Analysis”

Information Centre: “Linkage” & “Repository”

identifiable

Pre-op

IC

OtherSUSNJR

Post-opScoring,

outcomesAggregation

Academic stakeholders

Case-mix adjustment

Develop adjustment

Record-level data

Healthcare stakeholders

Extract Service

LinkedPseud’sed

Aggregateddata

Record level data

Record level data

PROMs “Administration”PROMs “Aggregation”

Linkage to HES

• Link to HES– Provides the demographics of the patient (very

minimum collected in the PROMs questionnaires) – Provides details of the operation (OPCS-4 codes) and

diagnosis (ICD-10) – Provides details of the commissioner and provider– Provides information on co-morbidities to aid casemix

adjustment– Ability to link to previous episodes of care

Linkage to National Joint Registry

• Link to NJR (for Hip & Knee replacements)– Provides more detailed data on the procedure

(techniques, prosthetics, cement etc)– Extra information on cause/reason

Matching Flowchart

HES id &episode matching

Pre-op QsQ1s

HESNJR

Participationrates

ScoringQ1s

Pre-op scores

Participationrates

Monthly indicators

Matching Flowchart

HES id &episode matching

Pre-op QsQ1s

HESNJR

Participationrates

ScoringQ1s

Pre-op scores

Match to Q1s

Post-op Qs

Q2s

ScoringQ1+Q2pairs

Responserates

Participationrates

Monthly indicators

Matching Flowchart

HES id &episode matching

Pre-op QsQ1s

HESNJR

Participationrates

ScoringQ1s

Pre-op scores

Match to Q1s

Post-op Qs

Q2s

ScoringQ1+Q2pairs

Responserates

Output for analysis & extracts

Analysis & casemix adjustment

Health Gain scores

Participationrates

Monthly indicators

IC Functions

• Pre-op & Post-op questionnaires scored and compared to provide health gain (using the instrument developer’s scoring algorithms)

• All the above provides the data for analysis• Aggregation/Analysis contractor is

developing and will routinely apply case-mix and risk adjustment in order to produce regularly average health gain data by commissioner (PCT) and provider

IC Publications & Management Information (monthly)

• Participation rates – based on the pre-op questionnaires

• Response rates – Completion of pre-op and post-op questionnaires

• Pre-op scores – unadjusted data, used for appropriateness of referrals, and exploring health inequalities

• Outcomes – Casemix adjusted to show health gain by provider & commissioner and maybe probability of a positive benefit

IC Extract Service

• PROMs data will be available through the HES data extract service, intended for providers and researchers

• Extra Ts & Cs to reflect PROMs licencing• Anonymised or pseudonymised patient id unless

with NIGB (Ethics Committee) approval • Sensitive HES fields only with NIGB (DMSG)

approval• Expect extract service to start from early 2010, but

dependent on sufficiently good data quality

Current Position

• Pre-op questionnaires started in April 09, for procedures in Apr, May & June

• First post-op questionnaires received by IC Sept 09 (3 months post op. for groin hernias & varicose veins)

Information Timing

• All timings will be dependent on the quality being sufficiently fit for purpose

• We expect to release the provisional management information on participation rates soon, and follow with response rates.

• Expect the extract service to start in early 2010• Expect indicators to be available later in 2010

(summer). These are new indicators, so need testing with sufficient volumes before release.

PROMs Outcomes Indicators

• Outcome indicators are expected to show health gain, casemix adjusted, by provider and commissioner (PCT)

• Will be available in Indicators for Quality Improvement (IQI)

• Will be supplied to NHS Choices• These indicators can then be used with

other indicators to provide a richer indication of the quality of care

Expected Use of PROMsLocal use of data

» » Benchmarking against peers leading to improvements

Quality Accounts

» » Telling the story about performance

CQUIN » » Financial rewards for high quality

Choice » » Choosing high quality providers

WCC » » Allocate scarce resources efficiently

Tackling health inequalities

» » Appropriate access for given needs

Regulation (CQC)

» » Setting minimum standards

Standard contracts

» » Commissioners holding providers to account

PROMs

Find out more

0845 300 6016

www.ic.nhs.uk