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Oxford International Health Conference 2015 1
Short Generic Patient-Reported Quality Measures
Tim BensonR-Outcomes Ltd
Oxford International Health Conference 27 June 2015
St Hugh’s College Oxford
Oxford International Health Conference 2015 2
Outline of Presentation
Short summary of programme since 2006Three aspects of patient perception
Health-related quality of life (howRu)Health Confidence Score (HCS)Patient experience (howRwe)
Data collection Feedback to improve quality and outcomes
DisclosuresTim Benson developed the tools and is a director of of R-Outcomes Ltd. The tools were developed without public money or other sponsorship.
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Everyone wants
To feel better and be able to do more(and a long life followed by a peaceful death)*
And receive excellent service
Most also want to be fully engaged in their care
We should measure quality against these criteria
* not discussed in this presentation
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howRuA short generic patient-reported outcome measure (PROM)1 Physical symptoms2 Mental symptoms3 Disability4 Dependency
Benson T et al. Evaluation of a new short generic measure of health status: howRu. Inf Prim Care 18 (2) 89-101. PDF
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Validation vs SF-12 and EQ-5D
Sources: SF-12 vs howRu: Benson T et al. Evaluation of a new short generic measure of health status: howRu. Inf Prim Care 18 (2) 89-101. PDF
EQ—5D vs howRu: Benson T et al. Comparison of howRu and EQ-5D measures of health-related quality of life in an outpatient clinic. Inf Prim Care 2013; 21 (1) 12-17. PDF
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Change between Pre-op and Post-op scores
Measure on 0-100 scaleHip
Replacementimprovement
Knee Replacementimprovement
Oxford hip and knee scores* 43 34howRu** 33 26EQ-5D*** 26 19EQ-VAS*** 10 5
0-100 scale allocates 0 to worst state and 100 to best state* Mean value for cohorts using howRu and EQ-5D (unweighted)** Mean value for 74 hip and 42 knee replacements*** Mean value for 29,129 hip and 29,907 knee replacements (NHS PROMs database)
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Correlations between generic and condition-specific measures for the difference between pre-operation and
post-operation scores
Generic vs Condition-specificHip
Replacement(r)
Knee Replacement
(r)howRu vs Oxford score 0.78 0.86EQ-5D vs Oxford Score 0.67 0.59EQ-VAS vs Oxford Score 0.33 0.31
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howRu index is aggregate score of howRu dimensions for each home converted to 0 (all at worst score) to 100 (all at best score)
Benson T, Bowman C. Health-Related Quality of Life and Patient Experience in Care Homes. Medicine 2.0 London, Sept 2013
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Health Confidence Score (HCS)Short generic measure of patient’s perception of their confidence to engage fully in health and care.
1 Knowledge2 Self-management3 Access4 Shared decision-making
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howRweShort generic measure of patient experience:
Clinical relationships1 Kindness2 CommunicationAdmin function3 Promptness4 Organisation
Benson T, Potts H. A short generic patient experience questionnaire: howRwe development and validation. BMC Health Services Research 2014, 14:499 PDF
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howRwe index is aggregate score of howRwe dimensions for each home converted to 0 (all at worst score) to 100 (all at best score)
Benson T, Bowman C. Health-Related Quality of Life and Patient Experience in Care Homes. Medicine 2.0 London, Sept 2013
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This shows howRwe dimension scores before making a change to the way that the clinic was run.
Benson T, Potts HWW. A short generic patient experience questionnaire: howRwe development and validation. BMC Health Services Research 2014, 14:499 PDF
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No change in clinical domains (kindness and communication). Significant improvement in administrative domains (promptness and organisation).
Benson T, Potts HWW. A short generic patient experience questionnaire: howRwe development and validation. BMC Health Services Research 2014, 14:499
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Design Criteria
ShortQuick and easy to useLow burdenRepeated use
GenericAll conditionsMultiple conditionsAll settings including social care
howRu Health Tracker
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Data collection modalities
Patient’s own device using text or email invitationsmartphone, PC or tablet
Provider’s devicekiosks, tablets or PCs
PaperOptical Mark Readable (OMR) formsPaper forms or postcards
Telephone human or interactive voice response (IVR)
Add to other surveys
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Automation
Automation reduces burden on staff and patientsData collection
Registration and consentSchedule frequency or trigger eventsSend patient invitationPatient completes and submits
AnalysisResults reception, validation and alertsAdd to EHR (Read or SNOMED CT coded)Analytics and dashboards Feedback
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Feedback
Rapid easy-to-understand feedback is essential to improve quality and outcomesFor all stakeholders
Patients and their familiesClinicians for clinical care and auditManagers for quality assurance and improvementCommissioners for value and accountability
The whole thing is waste unless people make different (better) decisions
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Summary
Summary of a nine-year development programme Recognised the need for short generic PROMs that are fit for purposeValidation studies show good resultsWe now have a practical tool set
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For more information or to use these tools please contact us
[email protected] +44 7855 682 037Webwww.r-outcomes.comTwitter @r_outcomes