Editor’s blog Monday 15 March 2010: New report on PROMS from Kings Fund & OHE

Morning. The new report out from the Kings Fund and the Office of Health Economics is worth reading. Getting the most out of PROMs: putting health outcomes at the heart of NHS decision-making by Nancy Devlin and the iridescent John Appleby.

BUPA director Andrew Vallance-Owen’s introduction wryly notes that the traditional NHS outcome measure – of death – is of no help in assessing whether the healthcare the NHS provides adds value.

Devlin and Appleby open with a 1997 quote from IHI supreme Don Berwisk: “The ultimate measure by which to judge the quality of a medical effort is whether it helps patients (and their families) as they see it. Anything done in health care that does not help a patient or family is, by definition, waste, whether or not the professions and their associations traditionally hallow it.”

Patient-reported outcome measures (PROMs) are, as the authors observe, “a landmark development”, but not one without complication. They point out that “patients, commissioners, providers, and clinicians will all have a keen interest in PROMs, but the most useful way of analysing and reporting PROMs data might differ for each of these groups”.

In the recessionary context, Devlin and Appleby suggest that Berwick’s point about the addition of value becomes of even higher importance, asking of the NHS budget, “What is produced from this spending? What value does expenditure on health services generate for patients and for the United Kingdom?”

They correctly add that “a fundamental rethink about what ‘outputs’ and ‘outcomes’ mean in the NHS is long overdue.”

An international first
They also add that PROMS will be “a first internationally: the NHS will be the first health care system in the world to measure what it produces in terms of health, rather than in terms of the production of health care”.

The report considers the opportunities that PROMs data present; the limitations of PROMs (and possible pitfalls in the use and overinterpretation of data produced from them); and asks what work needs to be done now in order to get the most out of PROMs.

It examines how PROMs data might be used by patients (both in choosing where to receive treatment, and also what treatment is best for them); and considers other ways in which the data now being collected can be used to transform decision-making in the NHS (and, by extension, in any health care system anywhere in the world).

It also suggests options for providers to use the data to benchmark and improve clinical performance within their own organisations.

The report’s blend of the technical and analytical with clear and concise explanation of its value to the range of users – clinicians, patients, providers and commissioners – will guarantee it a wide readership.