HaDSoc 5.2 patient reported outcomes

Question 1

Why should we measure health?

Answer 1

• Have an idea of the health needs
• helps with resource allocation
• can look at effectiveness of interventions
• monitor progress
• look at quality of health services (Are people happy with the service?)

Question 2

What are some commonly used measures of health?

Answer 2

• mortality
• morbidity
• patient reported outcomes

Question 3

What are some pros and cons of using mortality as a measure of health?

Answer 3

-it is easily defined

• its not always recorded properly (wont know the cause of death)
• not a good measure of outcome (death shouldn’t really be an outcome)

Question 4

What are some pros and cons of using morbidity as a measure of health?

Answer 4

-its already widely collected (general health checks etc)

• collection isnt always accurate
• not easy to evaluate
• no insight into the patients experiences.

Question 5

why use a patient-based outcome?

Answer 5

To attempt to assess well being from the patients perspective.

• good for conditions where there is no cure, just management.
• good for looking at iatrogenic effects of care (are certain parts of the treatment affecting the patient negatively?)

Question 6

What does PROMs stand for?

Answer 6

Patient reported outcomes measure.

Question 7

What are some uses of patient reported outcomes?

Answer 7

• used in audit
• used to evaluate quality of care
• used to look at effectiveness and benefits associated with cost
• used to measure health status of populations

Question 8

What happens to the data collected by proms?

Answer 8

• it’s published
• comparisons can be made between trusts
• patients can use it to help them make decisions
• of interest to commissioners

Question 9

What are some drawbacks of PROMs?

Answer 9

• take a lot of time to collect, analyse and publish
• difficult to get everyone to participate (introduces bias)
• need to make sure they arent being misused

Question 10

Define health related quality of life.

Answer 10

‘the functional effects of an illness and its consequent therapy upon a patient, as percieved by that patient.’

Question 11

How do we measure HRQoL?

Answer 11

• qualitative methods
• quantitative methods
  - specific or generic instruments

Question 12

What 2 properties must a quatitative instrument be, in order to be a good PROM?

Answer 12

• validity (does it measure what it should measure?)
• reliability (is it accurate over time and internally consistant, are any changes recorded due to a change in the condition, instead of the way the questions are asked etc)

Question 13

What are some advantages of using published instruments instead of unpublished, for PROMs?

Answer 13

-they’ve been proven to be reliable and valid
-you can compare across different groups becuase they are widely used.
-

Question 14

What are some advantages of generic instrument use for PROMs?

Answer 14

• you can use them on any population, including healthy people
• good for a broad range of problems
• can detect unexpected effects of interventions
• can assess the health of populations

Question 15

What are some disadvantages of generic instrument use for PROMs?

Answer 15

• Patients may not feel they’re relevant so may not complete them
• May be too broad, overlook things, be too general
• They’re less details
• less sensitive to changes that occur after an intervention

Question 16

What are some examples of generic measures for PROMs?

Answer 16

• Short form 36

- euroQOL EQ-5D.

Question 17

What is the SF 36? describe it’s properties.

Answer 17

A short questionaire of 36 questions, coverring 8 domains, which looks at health over the past 4 weeks.
Is widely used in research
proven to be reliable and valid.

Question 18

What are the 8 dimensions of the SF 36?

Answer 18

• physical functioning
• role functioning (physical)
• social functioning
• role functioning (emotional)
• bodily pain
• vitality
• mental health
• general health

Question 19

How does the scoring of the SF 36 work?

Answer 19

Scores relating to a single domain can be grouped together.
Scores across domains cannot. (takes more analysing)
No overall score.

Question 20

What are some advantages of the SF36?

Answer 20

• acceptible to people
• only takes 5-10 mins to fill out
• high internal consistency
• it’s responsive to change
• widely used so theres population data available for comparison.

Question 21

Discuss features of the EuroQol 5d.

Answer 21

questions 5 dimensions of health, and generates a single index between 0 (death) and full health (1).

Commonly used as a stand alone measure.

Question 22

What are the dimensions of the EQ 5d?

Answer 22

• mobility
• self care
• usual activities
• pain
• anxiety/depression.

(each has 3 levels, no problems, some problems, severe problems)

Question 23

What are the 3 types of specific instruments used for PROM’s?

Answer 23

• disease specific (eg asthma QoL questionaire)
• site specific (eg hip, shoulder)
• dimension specific (eg pain, depression)

Question 24

What are the advantages of specific instrument use for proms?

Answer 24

• very sensitive to change
• more acceptible to people
• very detailed (relevant)

Question 25

What are some disadvantages of using specific instruments for PROMS?

Answer 25

- may miss unexpected effects (very specific) - can't be used for people who don't have the disease - limited comparison

Question 26

What things must you think about if you want to use a specific instrument to measure patient reported outcomes?

Answer 26

- has someone used this instrument to measure this before? - does it have established validity and reliability? - is it suitable? - is it acceptable? - does it reflect patients concerns? - is it sensitive to change? - is it easy to administer and analyse?