L16- Patient-reported outcomes Flashcards
why measure health outcomes
- Indicate need for healthcare
- Target resources where they are needed most
- Assess effectiveness of health interventions
- Eval qual of health services
- Eval effectiveness to get better value for money
- To monitor patients progress
why measure health outcomes
- Indicate need for healthcare
- Target resources where they are needed most
- Assess effectiveness of health interventions
- Eval qual of health services
- Eval effectiveness to get better value for money
- To monitor patients progress
commonly used measures of health
mortality
morbidity
patient-based outcomes
mortality
i. Easily defined
ii. Not always recorded accurately
iii. Not a very good way of assessing outcomes and quality of care
morbidity
- Routinely collected e.g. disease registers, hospital episode stats
- Collection not always reliable/ accurate
- Tells us nothing about patients experience
- Not always easy to use in evaluation
patient based outcomes
• Attempts to assess well-being from the patient’s point of view e.g:
- Health related qualities of life (HRQoL)
- Health status
- Functional abilities
PRO
patient reported outcomes
what are patient reported otucomes
“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”
where are pros increasing used
in conditions where aim is managing rather than curing the disease
- Increasing quality instead of quantity may be more important
example of why PROs are important
A surgeon might report that the blood flow from a coronary artery bypass looks great, but that is not much use if the patient reports they still get out of breath and pained on exercise.
PROMS
patient reported outcome measures (PROMs)
what are PROMS
“The tools or instruments used to measure PROs: turn subjective experiences into numerical scores that can easily be utilized “
PROs and clinical trials
- As study end points (measures) o Particularly when minimal differences in survival or treatments have different side effects o PROM associated with survival - Monitor adverse events - Economic eval (QALYs)
PROs in clinical practice
- Improvements in patient-clinical communication (shared decision)
- Improve outcomes- routine collection of PROMs as part of cancer therapy and follow-up positively impacts survival and QoL.
- Increase patient satisfaction with care
- Less frequent healthcare visits
NHS Englands PROMS programme currently covers which two clinical procedures
- Hip and knee replacement
- PROMS collected by NHS made publicly available
what can PROMS indicate
outcome or quality of care delivered to NHS patients and enables providers, commissioners and other stakeholders to make informed changes to the delivery of their services
- these changes aims to improve outcomes and measurable benefits
PROMs enables patients to
make informed choices about their care
Quality of life (QoL)
multidimensional concept that includes domains related to physical, mental, emotional and social functioning
health related quality of life (HRQoL)
the functional effect of an illness and its consequent therapy upon a patient, as perceived by a patient
- Impact of treatments and disease processes on these holistic aspects of a persons life
- Physical function
a. Mobility, dexterity, range of movement, physical activity, activities of daily living (e.g. ability to eat, wash, dress)
- Symptoms
a. Pain, nausea, appetite, energy, vitality, fatigue, sleep rest
- Psychological well-being
a. Psychological illness: anxiety, depression, coping, positive well-being and adjustment, send of control, self esteem
- Social wellbeing
a. Family and intimate relations, social contact, integration, social opportunities, leisure activities, sexual activity and satisfaction
- Cognitive functioning
a. Cognition, alertness, concentration, memory, confusion, ability to communicate
- Personal constructs
a. Satisfaction with bodily appearance, stigma, life satisfaction, spirituality
commonly used measures of health
mortality
morbidity
patient-based outcomes
proms quantitative approach relies o
use of questionnaires knwo as instruments or sxales
morbidity
- Routinely collected e.g. disease registers, hospital episode stats
- Collection not always reliable/ accurate
- Tells us nothing about patients experience
- Not always easy to use in evaluation
patient based outcomes
• Attempts to assess well-being from the patient’s point of view e.g:
- Health related qualities of life (HRQoL)
- Health status
- Functional abilities
PRO
patient reported outcomes
what are patient reported otucomes
“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”
where are pros increasing used
in conditions where aim is managing rather than curing the disease
- Increasing quality instead of quantity may be more important
example of why PROs are important
A surgeon might report that the blood flow from a coronary artery bypass looks great, but that is not much use if the patient reports they still get out of breath and pained on exercise.
PROMS
patient reported outcome measures (PROMs)
what are PROMS
“The tools or instruments used to measure PROs: turn subjective experiences into numerical scores that can easily be utilized “
PROs and clinical trials
- As study end points (measures) o Particularly when minimal differences in survival or treatments have different side effects o PROM associated with survival - Monitor adverse events - Economic eval (QALYs)
PROs in clinical practice
- Improvements in patient-clinical communication (shared decision)
- Improve outcomes- routine collection of PROMs as part of cancer therapy and follow-up positively impacts survival and QoL.
- Increase patient satisfaction with care
- Less frequent healthcare visits
NHS Englands PROMS programme currently covers which two clinical procedures
- Hip and knee replacement
- PROMS collected by NHS made publicly available
what can PROMS indicate
outcome or quality of care delivered to NHS patients and enables providers, commissioners and other stakeholders to make informed changes to the delivery of their services
- these changes aims to improve outcomes and measurable benefits
PROMs enables patients to
make informed choices about their care
Quality of life (QoL)
multidimensional concept that includes domains related to physical, mental, emotional and social functioning
health related quality of life (HRQoL)
the functional effect of an illness and its consequent therapy upon a patient, as perceived by a patient
- Impact of treatments and disease processes on these holistic aspects of a persons life
- Physical function
a. Mobility, dexterity, range of movement, physical activity, activities of daily living (e.g. ability to eat, wash, dress)
- Symptoms
a. Pain, nausea, appetite, energy, vitality, fatigue, sleep rest
- Psychological well-being
a. Psychological illness: anxiety, depression, coping, positive well-being and adjustment, send of control, self esteem
- Social wellbeing
a. Family and intimate relations, social contact, integration, social opportunities, leisure activities, sexual activity and satisfaction
- Cognitive functioning
a. Cognition, alertness, concentration, memory, confusion, ability to communicate
- Personal constructs
a. Satisfaction with bodily appearance, stigma, life satisfaction, spirituality
two important properties of PROMS
reliability and validity
reliability
Is the instrument accurate over time and internally consistent? (If the patient has no change in health, she should get the same score each time she does the measure)
validity
Does the instrument actually measure what it is intended to measure?
published instruments must have
established reliability and validity- can be used to compare across different groups of patients using standardised measures
types of proms
generic and specific
generic PROM
Measure very broad aspects of health
Can be used in any patient population
Uses EuroQol EQ-5D
specific PROMS
disease specific
site specific
dimension specoofc
disease specific
o e.g. asthma quality of life questionnaire
o e.g. arthritis impact measurement scale (AIMs)
site specific
o Oxford Hip Score
o Shoulder disability questionnaire
dimension specific
o Beck depression inventory
o McGill pain questionnaire
example of a generic PROM
EuroQoL EQ-5D
EuroQoL EQ-5D
Provides simple descriptive profile
- Full health = 1
- Death= 0
5 dimensions of EQ-5D
mobility self-care usual activity pain/discomfort anxiety/ depression
how many levels in each dimension
3
o No problems
o Some/moderate problems
o Extreme problems
how many different states outlined by EQ-5D
243
EQ%D is usually in the forma of a …… but can be in the form of a ……
questionnaire
thermometer
advantages of generic proms like EQ5D
- Suitable for use across a broad range of health problems
- Can be used comparisons between treatments for different patient groups to assess comparative effectiveness
- Can be used within healthy populations to generative normative data that can be used to compare diff patient group
- Broad scope means they have potential to capture the influence of co-morbidity on health
- Can detect unexpected positive or negative effects of an intervention (useful for assessing the impact of new health car technologies when therapeutic effects are uncertain
disadvantages of generic proms like EQ5D
- Broad applicability means that some level of detail has to be sacrificed which may limit the relevance of generic instruments when applied to a specific patient population
- Less responsive to clinically important changes in health
PROMS can also be
disease-specific or symptom specific
example of disease- specific PROMS
oxford hip score - much more personalised to specific disease
symptom specific
fatigue impact scale
advantages of specific instrument
- Very relevant content
- Sensitive to change
- Acceptable to patients
disadvantages of specific instrument
- Can’t use them with people who don’t have the disease
- Comparison is limited
- May not detect unexpected effects
selecting an insturment
- Is there published work showing established reliability and validity?
- Have there been other published studies that have used this instrument successfully?
- Is it suitable for your area of interest?
- Does it adequately reflect patients’ concerns in this area?
- Is the instrument acceptable to patients?
- Is it sensitive to change?
- Is it easy to administer and analyse?
summary of PRO
- Patient-based outcomes are increasingly important and embedded in policies
- Outcomes such as HRQoL must be measured in valid and reliable ways
- Generic and disease-specific measures exist and have different advantages and disadvantages