Editor’s blog Thursday 16 September 2010: The Proms are over: long live PROMs

The Proms - the Promenade Concerts - are one of the UK's great cultural institutions. 2010 saw another great season.

PROMs - patient-reported outcome measures - are one of the UK's great cultural innovations. 2010 sees the publications of the first figures for the NHS in England, but results were mixed.

The published data sets the baseline for future performance, and must be seen in its Year Zero context. The essential figures giving the national picture are as follows below, but the website linked above can also be used to get a specially-tailored picture (though for bhighly-tailored data, you may have to pay):

"In the period from April 2009 to April 2010:
Participation and coverage
There were 258,415 eligible hospital episodes and 155,018 pre-operative questionnaires returned - a headline participation rate of 60.0%.

Of the 99,203 post-operative questionnaire sent out, 70,946 have been returned - a return rate of 71.5%.

Scores
As measured by their response to a series of questions about their condition (Oxford Hip and Knee Scores), 95.8% of hip replacement respondents and 91.6% of knee replacement respondents recorded joint related improvements following their operation.

As measured by their response to a series of questions about their condition (Aberdeen Varicose Vein Questionnaire score), 83.7% of varicose vein respondents recorded varicose vein related improvements following their operation.

Based on a combination of five key criteria concerning their general health (EQ-5D Index score), 87.0% of hip replacement respondents and 77.4% of knee replacement respondents recorded an increase in their general health following their operation, compared to 52.5% for varicose veins and 49.4% for groin hernias.

An increase in the patient's EQ-5D VAS score (current state of the patient's general health marked on a visual analogue scale) was recorded for 61.8% of hip replacement respondents and 50.2% of knee replacement respondents, compared to 40.6% for varicose vein and 37.9% for groin hernias".

Analysis
Jings.

In fact, double-jings.

Hip and knee joint replacement, as measured by the Oxford Hip And Knee Score (1996-8) for has a reasonable satisfaction score of over 90% for improvement.

Improvements in varicose vein surgery dips down just over 80% according to the Aberdeen Questionnaire (1999).

So far, so apparently good.

However, on the longer-established studies of EuroQol measures (1990), things look less rosy.

Those methodologies find that in comparison to the aforementioned methodologies, 7% fewer hip replacement respondents and 14% fewer knee replacement respondents recorded an increase in their general health following their operation. 52.5% of respondents reported improvements for varicose veins, and 49.4% for groin hernias.

How much better am I now?
On the significant measure of  the in rease in the current post-operative state of the patient's general health, increases were recorded for 61.8% of hip replacement respondents and 50.2% of knee replacement respondents - increases by comparison were 40.6% for varicose vein and 37.9% for groin hernias.

There is an issue to be considered, where the best-rated present health improvement for joint replacement found that four out of ten people with a hip replacement and five out of ten with knee replacement rate their pot-operative health as better.

Some of this could be about realism of people's expectations of health gain. But at those ratios, not all of it will be.