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The use of PROMs in a community setting

26 March 2015

Iain Cockley-Adams

Gloucestershire Care Services NHS Trust

PROMs (Patient Reported Outcome Measures) in Gloucestershire • Podiatry

Generic general health & well being PROM EQ5D condition specific PROMs Plus PREMs (Patient experience) 5,141 individual returns to date

• MSK Clinical Assessment & Triage Service (MSKCAT) Generic general health & well being PROM EQ5D condition specific PROMs Plus PREMs (Patient experience) 3,345 individual returns to date

• Reablement Generic general health & well being PROM EQ5D social care quality of life PROM ASCOT Plus PREMs (Patient experience) Pilot started February 2015.

What we get from PROMs

• Quality Measure effectiveness of what we do - from the patient/service users point of view Evidence to help improve service delivery Evidence for others in the health and social care community Triangulation data for PREMs

• Patient Engagement 50% response rate to a postal survey. Impact on Shared Decisions Making (perhaps?)

• Staff Engagement Relevant and useful data Positive and rewarding Ownership

Targets and other metrics“As a basis for assessing the value of the

more than £100 billion of taxpayers’ funds currently spent on the English NHS … these measures are hopelessly inadequate.” (Getting the most out of PROMs; Kings Fund, 2010)

Volume 87, Number 4, April 2009

“…measuring (patient experience) … may be of limited use as a basis for quality improvement and health system reform.” (How does satisfaction with the health-care system relate to patient experience? Bulletin of the World Health Organisation, 2009)

Measuring what we actually do

PROMs to inform clinical practice

Net loss Negative

51.2

41

58

0

10

20

30

40

50

60

70

new referral 90 days 12 months

High

er =

Wor

se

MOXFQ (Foot) - steroid injections MSKCAT + Podiatry

35

36.6

33.2

31

32

33

34

35

36

37

new referral 90 days 12 months

High

er =

Wor

se

OSS (Shoulder) - steroid injections

22.5

27.5 24.2

0

5

10

15

20

25

30

new referral 90 days 12 months

High

er =

Bes

t

OKS (Knee) - steroid injections

27.6

31.4

45

0

5

10

15

20

25

30

35

40

45

50

new referral 90 days 12 months

High

er =

Bes

t

OHS (Hip) steroid injections

Bimonthly GP clinical newsletter

NICE guidelines reinforced by our PROMs evidence - and shared with the GPs via the newsletter

Gloucester City PLT 9 July 2013

Activity Data: To March 2013

Iain Cockley-Adams

MSKCAT Service

• Reporting always includes some PROMS data

• GP PLT sessions always have

hand-outs with PROMs evidence.

PROMs in social care: Evaluating Reablement

Reablement: impact on general health & wellbeing EQ5D

Reablement: impact on “social care quality of life” ASCOT

ASCOT Domains (Adult Social Care Outcomes Toolkit)

Patient Engagement 50% response rate for postal survey

Thank you

Iain Cockley-AdamsGloucestershire Care Services NHS TrustIain.cockley-adams@glos-care.nhs.uk 0300 421 1613

March 2015