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PROMS benefits case study: Patient Reported Outcome Measures (PROMs) outputs

Patient Reported Outcome Measures (PROMs) overview

The Health and Social Care Information Centre (HSCIC) periodically releases PROMs statistical outputs, such as publications and record-level data extracts, to report on patients' health gains following elective treatment for knee replacements, hip replacements, varicose veins and groin hernia. The outputs aim to help providers and other stakeholders improve quality of care.


How PROMs have informed clinical practice

The HSCIC has produced a benefits case study describing how stakeholders have or are aiming to use the PROMs statistical outputs, in order to contribute to improvements in quality of care. Examples of uses, based on 2009/10 - 2013/14 (provisional) PROMs data, include:

  • Barnsley Hospital NHS Foundation Trust was a negative outlier in 2011/12 for primary hip replacements (on the Oxford Hip Score). The provider used PROMs data to:
    • evaluate their Enhanced Recovery Programme; and
    • introduce clinical changes to aid rehabilitation such as replacing home-based physiotherapy assessments with hospital-based classes and appointing an additional physiotherapist.

Provisional 2013/14 results (published Feb 2015) shows that Barnsley has progressed to being above the negative outlier threshold on the Oxford Hip Score (OHS) i.e. not a negative outlier in 2013/14.

  • CircleBath used PROMs data to help shape their Enhanced Recovery Programme. This included revising care pathways, standardising implant and anaesthetic protocols and providing patients with an extra physiotherapy appointment. From 2011/12 onwards, CircleBath has consistently reported health gains for primary knee replacements on the OKS that are above the England average. The provider has also been a positive outlier for primary hip replacements on the OHS for 2012/13 and 2013/14 (provisional data).
  • Derby Hospitals NHS Foundation Trust established a multidisciplinary team to review their knee surgery pathway and adapt their post-operative pain relief protocol. Provisional 2013/14 results show that Derby was above the England average for primary knee replacements on OKS.
  • Harrogate and District NHS Foundation Trust is aiming to contact patients with worsened PROMs scores and establish key issues affecting their health.
  • Northumbria NHS Healthcare Foundation Trust used journal papers (including two that used PROMs data) to inform clinical decisions for knee replacement surgeries. These included switching implant brands and moving away from replacing the kneecap surface (during surgery). Northumbria was a positive outlier for primary knee replacements on OKS in provisional 2013/14 results.
  • The Royal Orthopaedic Hospital NHS Foundation Trust linked PROMs data with local information systems, such as patient administration and theatre systems, to understand care and treatment patterns in patients where improvements were not reported.

Improved outcomes and measurable benefits resulting from PROMs uses

The table below sets out the improved outcomes and measurable benefits that the PROMs uses have contributed to (where applicable). The measurable benefits are based on full year finalised and provisional PROMS data (i.e. 2009/10 - 2013/14)

Provider/CCGImproved outcomes contributed toMeasurable benefits contributed to
Barnsley Hospital NHS Foundation TrustImproving the patient care pathway, with specific focus placed on improving improved rehabilitation services for knee and hip replacement surgeriesBarnsley was not a negative outlier on the OHS or the OKS according to provisional 2013/14 results published in February 2015.
CircleBath HospitalImproved knee replacement surgery care pathwayFrom 2011/12 onwards, CircleBath has consistently reported health gains for primary knee replacements on the OKS that are above the England average.
Improved hip replacement surgery care pathwayCircleBath has been a positive outlier for primary hip replacements on the OHS from 2012/13 onwards
Improved optimisation of the hip and knee replacement surgery pathwaysReduction in length of stay for knee replacement surgery from 3.9 days in 2011/12 to 3.4 days in 2013/14 (to Feb 2015) at CircleBath
Cost saving to the hospital through improved procurement rates for hip and knee implants

Reduction in procurement cost CircleBath for:

  • hip replacement implants of approximately £290 per implant from Nov 2014
  • knee replacement implants of approximately £600 per implant from Nov 2014
Derby Hospitals NHS Foundation TrustImproved rehabilitation of patients undergoing knee replacement surgery through changes in post-op analgesia, which has enabled earlier mobilisationDerby was above the England average for primary knee replacement on OKS in provisional 2013/14 results.
Northumbria NHS Healthcare Foundation TrustImproved surgical treatment for knee replacement proceduresNorthumbria was a positive outlier for primary knee replacements on OKS in provisional 2013/14 results.
NHS Vale of York CCGPatients making a more informed choice on treatment options and becoming more involved in the decision making process.n/a
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