Patient Reported Outcomes Flashcards
LO1: disc reasons for rise of pt based measures as outcomes of HC.
-why meas health:
Need for HC, targ resources, assess effectiven, eval qual of services, va for money wrt effectiven, monit pt progress.
-comm meas incl mort, morbid, pt based outcomes.
Mort eas def, not always acc, not good for ass outcomes and qual.
Morb routinely collec, not always acc, noth about pt exper, not always eas to use in eval.
Pt based: ass well being from pt view. Eg HRQoL, health status, func abils. PROMS come direc from pt. comp LT scores bef and after tx.
-why use pt based- incr in conds where aim to manage not cure. Biomed tests just one part of pic. Foc on pt concerns. Look at iatrogenic effs of care.
-pt based outcomes can-
Be used clinically, to ass cost benef, in clinic audit, to meas health status of pops, to comp intevrens in CT, meas service qual.
-why introd PROMs-
Impr clinic managem of pts- share decis. Sweden and US.
Comp providers- incr productiv by dem managem and impr qual by pt choice.
-NHS outcome framew- enhance QoL for LTCs, hlep recov from elective proced.
NHS eng PROMs prog curr covers hip repl, knee repl, groin hernia, varicose vein.
-data published, can be brok down by provider so comp. indic qual care and inform pt decis.
-challs- minimise time and cost of data collec and anal. Pt particip. Approp output for diff audiences. Avoid misuse. Expand to LTCs, emergency, ment health etc.
LO2: underst whats meant by health related qual of life (HRQoL) and why its meas is seen as valuable.
-QoL= indivs percep of posit in life in context of culture and val sys and in rel to expecs, stands and concerns. Sense of soc, emot and physic wellbeing which infls personal satisfac.
-HRQoL= QoL in clinic med repres func eff of an illn and its tx on a pt, as perceived by the pt.
-HRQoL multi dimens- physic func, symps, global judgements of health, psych wellbeing, soc wellbeing, cog func, personal constructs (satisfac), satisfac with care.
-meas- qualit or quantit (specif vs generic instruments) methods:
1) qualit- can give acc other methods cant. init look at dimensions, informing dev of quantit instrums. Resource hungry. Not easy to use in eval, esp RCTs.
2) quantit- use of Qairres as instrums or scales. Shoulf fulfill cert crit.
-2 imp props of PROMs:
Reliabil- is instruma cc over time and internally consis.
Validit- does meas whats intended to.
LO3: ID diff tolls avail for meas HRQoL, and the strengths and lims of each.
-published instrums- reliab and validit est. comp diff pt grps using stand measures. Can be used indiscrimin and inapprop.
-QoL measures:
1) generic instrums: any popn. gen cov perceps overall health. Also Qs on soc, emot and physic func, pain and self care.
Advs- broad range health probs, can use if no dis specif instrum, enab comp tx grps, detec unexpec pos/neg effs of interven, can ass popn health.
Disadvs- less detailed, loss of relev, can be sensit to changes due to interven, may be less acceptab to pts. .
-Egs-
SF 36 Qairre: der from longer Qairres of pt ass outcome, stand uses 4 week recall, acute 1 week recall, used lot in research, adap and tested for british popns, reliab, valid.
sugg uses- meas gen health, pop surveys, pt managem, resource alloc, audit tool, clinic tool.
Desc- conts 36 items can be grped to 8 dimens- physic func, soc func, role func (physic and emot), bod pain, vitality, gen health, ment health.
Scoring- resps scored, scores for each dimens added, score transformed to score for each dimens up to 100, CANT add up dimensions for overall score.
Perf- acceptab, 10 mins, good int consis, test retest high, resp to change, popn data avail.
EQ 5D: generic meas, simp descriptiv prof. Gens sing index val for health status (full health 1, death 0).
5 dimensions- mobil, slef care, us activs, pain, anx/dep.
3 levs for each dimens- no probs, some/mod probs, extr probs.
243 diff states health exp by comb.
Widely used, good popn data avail, well validated, reliab assessed. Good for use in econ evals.
2) specif instrums: evals series of health dimensions specif to a dis, site or dimension.
Types- dis specif, site specif, dimension specif.
Advs- relev, sensit to change, acceptab to pts.
Disadvs- cant use if not have dis, comp lim, may not detec unexpec effs.
Eg oxford hip score- covers 12 items- pain sev, diffic using transp, household shopping, stairs, limp, interf with usual work, washing, dressing, walk dist, stand from sit, sudd pain, pain at night. Rate eas to imposs.
LO4: underst how to select the approp HRQoL meas in a range of circumstances.
-pts to consid- Is there published reliabil and valid. Published studies used it succ. Suitab for area of int. Does it adeq reflec pt concerns in this area. Acceptab to pts. Sensit to change. Easy to admin and anal.
