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ESA 4 - HaDSoc > Patient-Reported Outcomes > Flashcards

Patient-Reported Outcomes Flashcards

1
Q

Why do we have to measure health?

A
  • Have an indication of the need for healthcare
  • Target resources where they are most needed
  • Assess the effectiveness of health interventions
  • Evaluate the quality of health services
  • Use evaluations of effectiveness to get batter value for money
  • Monitor patients progress
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2
Q

What are the commonly used measures of health?

A
  • Mortality
  • Morbidity
  • Patient-based outcomes
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3
Q

What is good about using mortality as a measure of health?

A

Easily defined

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4
Q

What are the disadvantages of using mortality as a measure of health?

A
  • Not always recorded accurately
  • Not a very good way of assessing outcomes and quality of care
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5
Q

How is morbidity data routinely collected?

A
  • Disease registers
  • Hospital episode statistics
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6
Q

What is the problem with using morbidity data as a measure of health?

A
  • Collection not always reliable/accurate
  • Tells us nothing about the patients’ experiences
  • Not always easy to use in evaluation
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7
Q

What do patient-based outcomes attempt to do?

A

Assess well-being from the patient’s point of view

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8
Q

Give three examples of patient-based outcomes

A
  • Health related quality of life
  • Health status
  • Functional abilities
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9
Q

What are patient-reported outcome measures (PROMs)?

A

Measures of health that come directly from patients

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10
Q

How do PROMs work?

A

By comparing scores before and after treatment, or over long periods

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11
Q

Why do we use PROMs?

A
  • Increase in conditions where aim is managing, rather than curing
  • Biomedical tests are just one part of the picture
  • Need to focus on patient’s concerns
  • Need to pay attention to iatrogenic effects of care
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12
Q

Where can PROMs be used?

A
  • Clinically
  • To assess benefits in relation to cost
  • In a clinical audit
  • To measure health status of populations
  • To compare interventions in a clinical trial
  • As a measure of service quality
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13
Q

How do PROMs improve clinical management of patients?

A

Through informed, shared decision making

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14
Q

Where are PROMs the principal motivation?

A

In Sweden and USA

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15
Q

What does PROMs allow for?

A

Comparison of providers (hospitals)

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16
Q

What is the advantage of using PROMs to compare providers?

A
  • Increased productivity through demand management
  • Improve quality through patient choice, purchasing, P4P etc
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17
Q

What is domain 2 of the NHS Outcomes Framework 2016/17?

A

Enhancing quality of life for people with long-term conditions, with HRQoL for people with long term conditions being the overarching indicator

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18
Q

What is domain 3 of the NHS Outcomes Framework 2016/17?

A

Helping people recover from episodes of ill health, or following injury, with the improvement area being total health gain as assessed by patients for elective procedures (measured using a PROM)

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19
Q

What does NHS England’s PROMs programme currently cover?

A

Four clinical procedures;

  • Hip replacements
  • Knee replacements
  • Groin hernia
  • Varicose vein
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20
Q

What happens in NHS Englands PROM programme?

A

PROMs are collected by all providers of NHS-funded care since April 2009, and made publicly available

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21
Q

Who publishes data about PROMs?

A

Health and Social Care Information Centre

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22
Q

What can be done with the data about PROMs in NHS Englands programme?

A

Data can be broken down by provider, so comparisons can be made between trusts

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23
Q

Why is data about PROMs of interest to commissioners?

A

It indicates quality of care provided

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24
Q

Why is data about PROMs of interest to patients?

A

To inform their decision making

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25
Q

What are the challenges of PROMs?

A
  • Minimising the time and cost of collection, analysis, and presentation of data
  • Achieving high rates of patient participation
  • Provide appropriate output to different audiences
  • Avoiding misuse of PROMs
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26
Q

What is the best current definition of health related quality of life?

A

‘Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient’

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27
Q

What does HRQoL emcompass?

A
  • Physical function
  • Symptoms
  • Global judgement of health
  • Psychological well being
  • Social well being
  • Cognitive functioning
  • Personal constructs
  • Satisfaction with care
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28
Q

What is considered in physical function?

A
  • Mobility
  • Dexterity
  • Range of movement
  • Physical activity
  • Activities of daily living
  • Ability to eat, wash, dress
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29
Q

What symptoms are considered in HRQoL?

A
  • Pain
  • Nausea
  • Appetite
  • Energy
  • Vitality
  • Fatigue
  • Sleep
  • Rest
30
Q

What is considered in psychological well-being?

A
  • Psychological illness
  • Anxiety
  • Depression
  • Coping
  • Positive well-being and adjustment
  • Sense of control
  • Self-esteem
31
Q

What is considered in social well-being?

A
  • Family and intimate relations
  • Sexual contact
  • Integration
  • Social oppotunities
  • Leisure activities
  • Sexual activity and satisfation
32
Q

What is considered in cognitive functioning?

A
  • Cognition
  • Alertness
  • Concentration
  • Memory
  • Confusion
  • Ability to concentrate
33
Q

What is considered in personal constructs?

A
  • Satisfaction with body appearance
  • Stigma
  • Life satisfaction
  • Spirituality
34
Q

What are the two main choices when measuring HRQoL?

A
  • Qualitative methods
  • Quantiative methods
35
Q

What is the advantage of measuring HRQoL using qualitative methods?

A
  • Very appropriate in some cases
  • Gives you access to parts other methods don’t reach
  • Good for initial look at dimensions of HRQoL
36
Q

What is the advantage of using qualitative methods at initially looking at the dimensions of HRQoL?

A

Informs development of quantitative methods

37
Q

What are the disadvantages of using qualitative methods when measuring HRQoL?

A
  • Very resource hungry
  • Not easy to use in evaluation
38
Q

Why are qualitative methods of looking at HRQoL very resource-hungry?

A

Need expert training and time

39
Q

What do quantitative methods of looking at HRQoL rely on?

A

The use of questionnaires known as ‘instruments’ or ‘scales’

40
Q

Who can generic instruments be used with?

A

Any population, including healthy people

41
Q

What do generic instruments cover?

A
  • Perceptions of overal health
  • Social, emotional, and physical functioning
  • Pain
  • Self-care
42
Q

What are the advantages of generic instruments?

A
  • Can be used for a broad range of health problems
  • Can be used if no disease-specific instrument
  • Enable comparisons across treatment groups
  • Can be used to detect unexpected positive/negative effects of an intervention
  • Can be used to assess health of populations
43
Q

What are the disadvantages of generic instruments?

A
  • Generic nature means inherently less detailed
  • Loss of relevance
  • Can be less sensitive to changes that occur as a result of an intervention
  • May be less acceptable to patients
44
Q

Give 2 examples of generic instruments

A
  • The Short-Form 36-item questionnaire
  • The Euro-Qol ED-5D
45
Q

What was the Short-Form 36-item questionnaire developed from?

A

Instruments used in two large-scale studies conducted in the USA

46
Q

What have short-form questionnaires been derived from?

A

The longer (108 item) questionnaires of patient-assessed outcome

47
Q

What period of recall does the standard version of the short-form 36-item questionnaire use?

A

4 weeks

48
Q

What period of recall does the acute version of the short-form 36-item questionnaire use?

A

1 week

49
Q

What is the short-form 36 item questionnaire adapted and tested for?

A

British populations

50
Q

Is the short-form 36-item questionnaire reliable and valid?

A

Yes

51
Q

What does the short-term 36-item questionnaire contain?

A

36 items, which can be grouped into 8 dimensions;

  • Physical functioning
  • Social functioning
  • Role functioning (physical)
  • Role functioning (emotional)
  • Bodily pain
  • Vitality
  • General health
    Mental health
52
Q

What happens to the responses to the questions in the short-form 36-item questionnaire?

A

Responses to questions are scored, and scored for items within each dimension are added together. This score is transformed to give each respondant’s score for each dimension (0-100). You are not allowed to add up the dimensions to give an overall score, which can make interpretation difficult in some cases

53
Q

What are the advantages of the short-form 36-item questionnaire?

A
  • Acceptable to people
  • 5-10 mins for completion
  • Internal consistency good
  • Test retest high
  • Responsive to change
  • Population data available
54
Q

What does the Euro-Qol EQ-5D provide?

A

Simple descriptive profile

55
Q

What does Euro-Qol EQ-5D generate?

A

A single index value for health status on which full health is assigned a value of 1, and death a value of 0

56
Q

What are the dimensions of the Euro-Qol EQ-5D?

A
  • Mobility
  • Self care
  • Usual activities
  • Pain/discomfort
  • Leisure activities
57
Q

What usual activites are considered in the Euro-Qol EQ-5D?

A
  • Work
  • Study
  • Housework
  • Family
  • Leisure activities
58
Q

What are the levels for each dimension in the Euro-Qol EQ-5D?

A
  • No problems
  • Some/moderate problems
  • Extreme problems
59
Q

What was the Euro-Qol EQ-5D originally designed for?

A

To complement other measures such as SF-36, but increasingly used as a stand-alone measure

60
Q

What are the advantages of the EuroQol EQ-5D?

A
  • Widely used
  • Good population data available
  • Well validated and tested for reliability
  • Particularly suitable for use in economic evaluations
61
Q

What do specific instruments do?

A

Evaluates a series of health dimensions specific to a disease, site, or dimension

62
Q

What are the advantages of specific instruments?

A
  • Very relevant content
  • Sensitive to change
  • Acceptable to patients
63
Q

What are the disadvantages of specific instruments?

A
  • Can’t use them with people who don’t have the disease
  • Comparison is limited
  • May not detect unexpected effects
64
Q

What should be considered when selecting an instrument?

A
  • Is there published work showing established reliability and validity?
  • Have there been other published studies that have used this instrument successfully?
  • It is 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?
65
Q

What are the important qualities of PROMs?

A
  • Reliability
  • Validity
66
Q

What is meant by relability?

A

Is the instrument accurate over time and internally consistent

67
Q

What is meany by validity?

A

Does the instrument actually measure what it is intended to measure

68
Q

What is the advantage of published instrument?

A

They have their reliability and validity established

69
Q

What can published instruments be used for?

A

To compare across different groups of patients using standardised measures

70
Q

What is the risk with published instruments?

A

Can be used indiscriminately and inappropriately

ESA 4 - HaDSoc (13 decks)

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