L17: Patient Reported Outcomes

Question 1

Why measure health outcomes?

Answer 1

• Indication of the need for healthcare
• Target resources where they are most needed
• Assess the effectiveness of health interventions
• Evaluate the quality of health of services
• Use evaluations of effectiveness to get better value for money
• Monitor patients progress

Question 2

What parameters are commonly used to measure health outcomes?

Answer 2

Mortality
Morbidity
Patient based outcomes

Question 3

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

Answer 3

Easily defined
Not always recorded accurately
Not good way of accessing outcomes and quality of care

Question 4

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

Answer 4

Routinely collected → disease registers, hospital statistics
Collection not always reliable/ accurate
Tells us nothing about the patients experience
Not always easy to use in evaluation

Question 5

Why are patient reported outcomes (PROs) used?

Answer 5

Attempt to assess the well-being from a patients point of view
e.g. health related quality of life (HRQol), health status, functional abilities

Question 6

What is the definition of PROs?

Answer 6

Any report of status of a patient’s health condition that comes directly from the patient, without interpretation o the patients response by a clinician or anyone else

Question 7

What are patient reported outcome measures (PROMs)?

Answer 7

Tool or instrument to measure PROs, turn subjective experiences into numerical scores that can easily be utilised

Question 8

Why are patient reported outcome increasingly being used?

Answer 8

• Increase in conditions where aim is managing rather than curing
• Biomedical tests just one part of picture → no idea of how it feels to have the condition
• Patient centred care → focus on patients concerns
• Need to pay attention to the iatrogenic aspects of care → illness that is caused by care
• Some people quality of life is better than quantity
• Patients and clinicians have different priorities and perspectives

Question 9

What does quality of life include?

Answer 9

Multi-dimensional concept that includes domains related to physical, mental, emotional and social functioning

Question 10

What does Health related quality of life mean?

Answer 10

Impact of treatments and disease processes on these holistic aspects of a person’s life

Question 11

What does health related quality of life (HRQoL) include?

Answer 11

Physical function 
Symptoms 
Global judgement of health 
Psychological well-being 
Social wellbeing 
Cognitive functioning 
Personal constructs (body appearance, stigma, spirituality etc...)
Satisfaction with care

Question 12

How do you get PROMs?

Answer 12

Quantitative approach relies on use of questionnaires known as ‘instruments’ or ‘scales’

Question 13

What are two important properties of PROMs?

Answer 13

Reliability→ instrument accurate over time and internally consistent?
Validity→ does the instrument actually measure what is is intended to measure? (all aspects of PROs)

Question 14

What are the different types of PROMs?

Answer 14

Generic→ any patient population
Specific→
- Disease specific → Asthma QoL Questionnaire
- Site specific → oxford hip score
- Dimension specific → Beck Depression Inventory

Question 15

Give an example of a generic PROM?

Answer 15

The EuroQoL EQ-5D
Generic measure, provides simple descriptive profile
Single index value of health status on which full health is assigned a value of 1 and a death value of 0

Question 16

What are the dimensions of the EQ-5D? What are the 3 levels for each dimension?

Answer 16

5 dimensions
→ Mobility 
→ Self-care
→ Usual activities (work, study, family, leisure activities)
→ Pain/ Discomfort
→ Anxiety/ Depression 

3 levels
→ No problems
→ Some/ Moderate problems
→ Extreme problems

Creates 243 different health states

Question 17

What are the advantages and disadvantages of generic PROMs?

Answer 17

Advantages→ broad range of health problems
Disadvantages→ loss of relevance, can be less sensitive to changes that occurs as a result of intervention, less acceptable to patients

Question 18

What are the advantage and disadvantages of specific PROMs?

Answer 18

Advantages→ very relevant content, sensitive to change, acceptable to patients
Disadvantages→ Can’t use them with people who don’t have the disease, comparison is limited , may not detect unexpected results

Question 19

What considerations do you need to make when selecting an instrument?

Answer 19

• 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?