Patient reported outcomes | Andrew Vallance-Owen

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A presentation by Andrew Vallance-Owen on Patient Reported Outcomes at the diagnosis Salon on 28th April.

Health & Medicine Spiritual Business

PATIENT REPORTED OUTCOMES International Forum on Quality and Safety in Healthcare Breakfast Session Andrew Vallance-Owen Group Medical Director 7 April 2011

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EQ-5D Kind, P. et al. BMJ 1998;316:736-741

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VF-14 (Visual Function) – extract from 14 questions

Baseline data can be interesting in their own right: VF-14 pre-op scores, where 100 = no visual problems 0 10 20 30 40 50 60 70 80 90 100 0 3 5 8 11 13 16 19 21 24 27 29 32 35 38 40 43 46 48 51 54 56 59 62 64 67 70 72 75 78 80 83 86 88 91 94 96 99 Percentage of patients (N=824) VF-14 score (100 = no visual problems)

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Recruitment varies by procedure % of patients completing baseline questionnaire, NHS data Hips and knees – 70 to 80% Hernia – 50 to 60% Varicose vein – 40 to 50%

EQ-5D responsiveness? Note number “Same” and “Unknown” … compared with condition-specific tools:

How NHS data have been presented (as experimental statistics) http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295

How the NHS data can be shown - funnel plot Oxford Hip change scores by hospital, April ’09 to April ’10 data NHS Experimental Statistics

The future of PROMS? The ‘howRu’ howRu 35 words EQ-5D 230 words SF-12 451 words SF-36 779 words

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Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

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The specialized industry of collecting electronic patient-reported outcomes is increasing linearly, in part because global government regulators want to hear directly from the patient, and because the acceleration and availability of electronic collection (vs. paper collection) improves data quality and efficiencies for data analysis and trial management. This document will review the ePRO market, and outline the five ePRO methods what successfully support the collection of patient-reported data

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Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) have been used in healthcare since the 1970s. But the industry hasn’t had meaningful, consistent PROs and PROMs definitions until ICHOM developed one. ICHOM, a pioneer in outcomes measurement and improvement, demonstrates that healthcare organizations focused on improving patient outcomes that patients actually care about are the ones most likely to transform healthcare. PROs and PROMs complement clinical indicators in understanding the quality of healthcare a team is delivering. For example, an improvement program for prostate cancer patients that only focuses on improving blood loss or length of stay in the hospital completely misses a patient’s biggest fears: will they need to wear pads for the rest of their life? Will their relationship with their partner be the same as it was? By focusing on outcomes that matter most to patients, health systems will be more successful at improving outcomes. ICHOM describes five strategies for getting started with PROs and PROMs: Find the Believers (Identify Clinician Champions) Organize a Cross-Functional Team (with Appropriate Governance) Invest Time and Resources Celebrate Progress Along the Way Use Early Successes to Scale and Spread

Improving the Outcomes That Matter Most to Patients

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Patient-reported outcomes (PROs), defined as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else,” are the future of healthcare. In addition to helping people like 80-year-old-Ruth continue to live interpedently, PROs—interchangeable with the term patient-generated health data (PGHD)—have several benefits: Effectively supplement existing clinical data, filling in gaps in information and providing a more comprehensive picture of ongoing patient health. Provide important information about how patients are doing between medical visits. Gather information on an ongoing basis—rather than just one point in time—and provide information relevant to preventive and chronic care management. The new technologies that enable PROs and PGHD (e.g., sensors that detect whether Ruth takes food out of her refrigerator on a regular basis), generate important data outside of patients’ traditional care environments, sharing it with care teams to expand the depth, breadth, and continuity of information available to improve healthcare and outcomes.

Why Patient-Reported Outcomes Are the Future of Healthcare

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Care management systems are defined in many ways, but the only effective system comprises three qualities: 1.) It’s comprehensive and includes a suite of tools to address all five core competencies of care management. 2.) It’s inclusive of all EMRs and other data sources to enable thorough communication and analysis. 3.) It’s analytics-driven design facilitates clinical decision making and workflow. Ultimately, an effective system improves outcomes and becomes an indispensable tool for managing population health. This article describes what drives successful care management, and reveals a suite of applications that aid care team members and patients through advanced algorithms and embedded analytics. Learn how technology is helping to develop appropriate interventions and improve clinical and financial outcomes.

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The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10] Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.

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