proms martin orton – nhs information centre
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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 - PowerPoint PPT PresentationTRANSCRIPT
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