Patient reported outcome measures raise questions of how need for operations is decided
HSJ’s revelation this week that tens of millions of pounds are being spent on treatments that arguably do not improve patients’ lives serves to focus minds.
The requirement to ask patients how they feel after hip and knee replacements and surgery for groin hernias and varicose veins is a direct result of health minister Lord Darzi’s next stage review.
A surgeon himself, the minister has championed the introduction of patient reported outcome measures as a necessary corollary in the drive to improve quality across the health service.
Its ambition should be celebrated: this is the first time that PROMs have been collected across an entire health system anywhere in the world.
The possibilities for its use are numerous and exciting. While primary care trusts may not yet be ready to use it as a tool to see where money could be better spent - further down the line PROMs’ potential as a commissioning tool is clear.
In the meantime, PCTs and clinicians should certainly start looking at whether those patients who report having little wrong with them before an operation - and no improvement afterwards - have actually been offered the right treatment in the first place.
Taking the logic further, the measures could be used in future to work out the relative cost of different treatments, not just financially but in how they affect quality of life too.
In a week when the Commons health select committee has criticised the National Institute for Health and Clinical Excellence for allowing less cost-efficient drugs to be given to people at the end of their lives, adding PROMs to the mix allows PCTs another way to consider how they slice the cake.
And it is not just commissioners and healthcare providers who will instantly gain a better understanding of how effective treatments are, but the very patients who are doing the reporting.
They will be better able to make informed choices. And they may gain a more realistic understanding of the cost of healthcare to boot.
What do you think? Email hsj.feedback@emap.com or comment on our online forums, www.hsj.co.uk/forums
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Readers' comments (1)
Tim Benson | 14-May-2009 12:16 pm
I agree that measuring PROMs will bring benefits at all levels, to commissioners and managers as well as to patients and clinicians.
More than 10 years ago Donald Berwick wrote in the BMJ that: "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."
Waste is waste, even if it is efficient, safe and courteous.
Tim Benson
Routine Health Outcomes Ltd
Reference:
Berwick DM. Medical associations: guilds or leaders. BMJ 1997: 314: 1564 (http://www.bmj.com/cgi/content/full/314/7094/1564)
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