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Population and Social Science > L16- Patient-reported outcomes > Flashcards

L16- Patient-reported outcomes Flashcards

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1
Q

why measure health outcomes

A
  • 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
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2
Q

why measure health outcomes

A
  • 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
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3
Q

commonly used measures of health

A

mortality
morbidity
patient-based outcomes

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4
Q

mortality

A

i. Easily defined
ii. Not always recorded accurately
iii. Not a very good way of assessing outcomes and quality of care

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5
Q

morbidity

A
  • 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
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6
Q

patient based outcomes

A

• Attempts to assess well-being from the patient’s point of view e.g:

  1. Health related qualities of life (HRQoL)
  2. Health status
  3. Functional abilities
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7
Q

PRO

A

patient reported outcomes

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8
Q

what are patient reported otucomes

A

“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”

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9
Q

where are pros increasing used

A

in conditions where aim is managing rather than curing the disease
- Increasing quality instead of quantity may be more important

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10
Q

example of why PROs are important

A

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.

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11
Q

PROMS

A

patient reported outcome measures (PROMs)

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12
Q

what are PROMS

A

“The tools or instruments used to measure PROs: turn subjective experiences into numerical scores that can easily be utilized “

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13
Q

PROs and clinical trials

A 
-	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)
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14
Q

PROs in clinical practice

A
  • 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
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15
Q

NHS Englands PROMS programme currently covers which two clinical procedures

A
  • Hip and knee replacement

- PROMS collected by NHS made publicly available

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16
Q

what can PROMS indicate

A

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

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17
Q

PROMs enables patients to

A

make informed choices about their care

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18
Q

Quality of life (QoL)

A

multidimensional concept that includes domains related to physical, mental, emotional and social functioning

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19
Q

health related quality of life (HRQoL)

A

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

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20
Q
  1. Physical function
A

a. Mobility, dexterity, range of movement, physical activity, activities of daily living (e.g. ability to eat, wash, dress)

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21
Q
  1. Symptoms
A

a. Pain, nausea, appetite, energy, vitality, fatigue, sleep rest

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22
Q
  1. Psychological well-being
A

a. Psychological illness: anxiety, depression, coping, positive well-being and adjustment, send of control, self esteem

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23
Q
  1. Social wellbeing
A

a. Family and intimate relations, social contact, integration, social opportunities, leisure activities, sexual activity and satisfaction

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24
Q
  1. Cognitive functioning
A

a. Cognition, alertness, concentration, memory, confusion, ability to communicate

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25
Q
  1. Personal constructs
A

a. Satisfaction with bodily appearance, stigma, life satisfaction, spirituality

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26
Q

commonly used measures of health

A

mortality
morbidity
patient-based outcomes

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27
Q

proms quantitative approach relies o

A

use of questionnaires knwo as instruments or sxales

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28
Q

morbidity

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

patient based outcomes

A

• Attempts to assess well-being from the patient’s point of view e.g:

  1. Health related qualities of life (HRQoL)
  2. Health status
  3. Functional abilities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PRO

A

patient reported outcomes

31
Q

what are patient reported otucomes

A

“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”

32
Q

where are pros increasing used

A

in conditions where aim is managing rather than curing the disease
- Increasing quality instead of quantity may be more important

33
Q

example of why PROs are important

A

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.

34
Q

PROMS

A

patient reported outcome measures (PROMs)

35
Q

what are PROMS

A

“The tools or instruments used to measure PROs: turn subjective experiences into numerical scores that can easily be utilized “

36
Q

PROs and clinical trials

A 
-	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)
37
Q

PROs in clinical practice

A
  • 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
38
Q

NHS Englands PROMS programme currently covers which two clinical procedures

A
  • Hip and knee replacement

- PROMS collected by NHS made publicly available

39
Q

what can PROMS indicate

A

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

40
Q

PROMs enables patients to

A

make informed choices about their care

41
Q

Quality of life (QoL)

A

multidimensional concept that includes domains related to physical, mental, emotional and social functioning

42
Q

health related quality of life (HRQoL)

A

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

43
Q
  1. Physical function
A

a. Mobility, dexterity, range of movement, physical activity, activities of daily living (e.g. ability to eat, wash, dress)

44
Q
  1. Symptoms
A

a. Pain, nausea, appetite, energy, vitality, fatigue, sleep rest

45
Q
  1. Psychological well-being
A

a. Psychological illness: anxiety, depression, coping, positive well-being and adjustment, send of control, self esteem

46
Q
  1. Social wellbeing
A

a. Family and intimate relations, social contact, integration, social opportunities, leisure activities, sexual activity and satisfaction

47
Q
  1. Cognitive functioning
A

a. Cognition, alertness, concentration, memory, confusion, ability to communicate

48
Q
  1. Personal constructs
A

a. Satisfaction with bodily appearance, stigma, life satisfaction, spirituality

49
Q

two important properties of PROMS

A

reliability and validity

50
Q

reliability

A

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)

51
Q

validity

A

Does the instrument actually measure what it is intended to measure?

52
Q

published instruments must have

A

established reliability and validity- can be used to compare across different groups of patients using standardised measures

53
Q

types of proms

A

generic and specific

54
Q

generic PROM

A

 Measure very broad aspects of health
 Can be used in any patient population
 Uses EuroQol EQ-5D

55
Q

specific PROMS

A

disease specific

site specific

dimension specoofc

56
Q

disease specific

A

o e.g. asthma quality of life questionnaire

o e.g. arthritis impact measurement scale (AIMs)

57
Q

site specific

A

o Oxford Hip Score

o Shoulder disability questionnaire

58
Q

dimension specific

A

o Beck depression inventory

o McGill pain questionnaire

59
Q

example of a generic PROM

A

EuroQoL EQ-5D

60
Q

EuroQoL EQ-5D

A

Provides simple descriptive profile

  • Full health = 1
  • Death= 0
61
Q

5 dimensions of EQ-5D

A 
mobility
self-care
usual activity
pain/discomfort
anxiety/ depression
62
Q

how many levels in each dimension

A

3
o No problems
o Some/moderate problems
o Extreme problems

63
Q

how many different states outlined by EQ-5D

A

243

64
Q

EQ%D is usually in the forma of a …… but can be in the form of a ……

A

questionnaire

thermometer

65
Q

advantages of generic proms like EQ5D

A
  • 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
66
Q

disadvantages of generic proms like EQ5D

A
  • 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
67
Q

PROMS can also be

A

disease-specific or symptom specific

68
Q

example of disease- specific PROMS

A

oxford hip score - much more personalised to specific disease

69
Q

symptom specific

A

fatigue impact scale

70
Q

advantages of specific instrument

A
  • Very relevant content
  • Sensitive to change
  • Acceptable to patients
71
Q

disadvantages of specific instrument

A
  • Can’t use them with people who don’t have the disease
  • Comparison is limited
  • May not detect unexpected effects
72
Q

selecting an insturment

A
  • 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?
73
Q

summary of PRO

A
  • 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

Population and Social Science (14 decks)

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