Oxford International Health Conference 2015 1

Short Generic Patient-Reported Quality Measures

Tim BensonR-Outcomes Ltd

Oxford International Health Conference 27 June 2015

St Hugh’s College Oxford

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Outline of Presentation

Short summary of programme since 2006Three 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

DisclosuresTim Benson developed the tools and is a director of of R-Outcomes Ltd. The tools were developed without public money or other sponsorship.

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Three aspects of patient perception

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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

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howRuA short generic patient-reported outcome measure (PROM)1 Physical symptoms2 Mental symptoms3 Disability4 Dependency

Benson T et al. Evaluation of a new short generic measure of health status: howRu. Inf Prim Care 18 (2) 89-101. PDF

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Validation vs SF-12 and EQ-5D

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

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Change between Pre-op and Post-op scores

Measure on 0-100 scaleHip

Replacementimprovement

Knee Replacementimprovement

Oxford hip and knee scores* 43 34howRu** 33 26EQ-5D*** 26 19EQ-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)

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Correlations between generic and condition-specific measures for the difference between pre-operation and

post-operation scores

Generic vs Condition-specificHip

Replacement(r)

Knee Replacement

(r)howRu vs Oxford score 0.78 0.86EQ-5D vs Oxford Score 0.67 0.59EQ-VAS vs Oxford Score 0.33 0.31

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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

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Health Confidence Score (HCS)Short generic measure of patient’s perception of their confidence to engage fully in health and care.

1 Knowledge2 Self-management3 Access4 Shared decision-making

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howRweShort generic measure of patient experience:

Clinical relationships1 Kindness2 CommunicationAdmin function3 Promptness4 Organisation

Benson T, Potts H. A short generic patient experience questionnaire: howRwe development and validation. BMC Health Services Research 2014, 14:499 PDF

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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

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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

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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

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Design Criteria

ShortQuick and easy to useLow burdenRepeated use

GenericAll conditionsMultiple conditionsAll settings including social care

howRu Health Tracker

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Data collection modalities

Patient’s own device using text or email invitationsmartphone, PC or tablet

Provider’s devicekiosks, tablets or PCs

PaperOptical Mark Readable (OMR) formsPaper forms or postcards

Telephone human or interactive voice response (IVR)

Add to other surveys

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Length

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Automation

Automation reduces burden on staff and patientsData collection

Registration and consentSchedule frequency or trigger eventsSend patient invitationPatient completes and submits

AnalysisResults reception, validation and alertsAdd to EHR (Read or SNOMED CT coded)Analytics and dashboards Feedback

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Feedback

Rapid easy-to-understand feedback is essential to improve quality and outcomesFor all stakeholders

Patients and their familiesClinicians for clinical care and auditManagers for quality assurance and improvementCommissioners for value and accountability

The whole thing is waste unless people make different (better) decisions

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Summary

Summary of a nine-year development programme Recognised the need for short generic PROMs that are fit for purposeValidation studies show good resultsWe now have a practical tool set

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For more information or to use these tools please contact us

Emailinfo@r-outcomes.comTel +44 7855 682 037Webwww.r-outcomes.comTwitter @r_outcomes