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Changes are being made to the list of elective surgeries covered by the national Patient Reported Outcome Measures (PROMs) programme – which provides information on how patients feel they benefited from their operation. Richard Ashworth explains what’s happening and why:
Patient Reported Outcome Measures (PROMs) measure health-related quality of life as reported by patients themselves.
“Before and after” questions on each side of a clinical intervention can sometimes help assess the real health gain that patients feel as opposed to the surgical success of, say, replacing a hip.
An operation might seem to have gone well from a surgical perspective, but the reality could be that a patient experiences little change in mobility or in the level of discomfort they experience and might even feel it was not worth it. PROMs data provide a measurable way to feed back this information to those who provide the surgery.
The national PROMs programme began in 2009 with the aim of increasing understanding of the difference various interventions could make to quality of life.
Four surgical procedures were chosen to be included: total hip replacement; total knee replacement; varicose veins and groin hernia surgery
Last year, NHS England carried out a consultation with clinicians, commissioners, patients, academics and others to understand how the national PROMs Programme is currently working, and how it should be developed in the future. A wide range of stakeholders told us what they thought.
NHS England has now published the full consultation report and has announced some changes to which procedures are included, ending collection of PROMs data relating to varicose vein and groin hernia operations.
The consultation recorded a wide range of views on PROMs, from those highlighting the burden of the current national collections, to those underlining their importance. While many champion PROMs for ensuring that patients have a direct say in how the quality of their care is determined, some feel that the process does not go far enough in measuring what is most important to patients.
Respondents identified the main purposes of PROMs as demonstrating the effectiveness of treatments by providing evidence of health gain, and providing information to reduce variation in care by highlighting where there are differences between organisations.
The consultation gathered evidence of PROMs being used in innovative and effective ways to improve the delivery of services, to inform the allocation of commissioning resources, and by Patient Participation Groups to raise questions about care quality. While this is good practice, it is clear that in many cases the potential of PROMs is not being realised in these ways.
The availability and presentation of the data is seen as a particularly significant barrier to the wider use of PROMs results, with many finding the current published products difficult to access, interpret and act upon. The time taken to produce results is also recognised as a barrier to their use in service improvement.
Many identified the fact that PROMs are currently collected on paper as an issue. By making results available in real time, electronic collection could in principle facilitate many new uses of PROMs, while still ensuring that results can be reported at the national level.
Mixed views were expressed about the continuation of the existing PROMs programme, but the hip and knee replacement PROMs were broadly identified as providing useful data about different aspects of these treatments. The varicose vein and groin-hernia collections, by contrast, are overall viewed as less useful so we are removing the burden on NHS organisations of continuing to collect this data.
We have taken into account that:
Surgical treatment of varicose veins is currently much less frequent and the condition is usually not a major cause of patient debility;
Groin hernia surgery is offered mainly to reduce the risk of requiring emergency surgery, rather than to relieve symptoms, which are often relatively minimal. This, along with the fact that there is no condition-specific measure for groin-hernia surgery, means the existing PROM has limited value.
NHS England will continue with hip and knee surgery PROMs collections and is working with NHS Digital to make the national data on them easier to use as well as to provide a range of automated outputs that are tailored to the needs of trusts, CCGs and other users.
The mandatory varicose vein surgery and groin-hernia surgery national PROMs collections ended on 1st October, though providers who want to continue them as a local initiative can still do that.
The consultation has been really important in identifying the best ways to take this programme forward and we are very grateful to everyone who took the time to give their views and expertise.
- If you have any queries about the PROMs consultation or new processes, please email firstname.lastname@example.org.