If you are a primary care or acute trust (or an independent provider of NHS-purchased care), are you planning for one of the most significant breakthroughs in NHS quality measurement?



From April 2009, as the 2008 operating framework NHS standard contract highlighted, the monthly clinical quality performance report should include data on patient-reported outcome measures (PROMs) for four operations: hips, knees, hernias and varicose veins. Around 280,000 patients a year should be reporting on the state of their health.

The implications for the NHS, patients and the public of these patient-reported outcome measures will be profound. For the first time, there will be a quantified measure of both generic and disease-specific quality of care received. The possible uses for this information are extensive. For example, for the first time, the NHS will have a way to adjust its crude activity-based productivity measures for quality. Patients will gain a real measure of quality, to help them make informed choices about hospitals/specialists. And primary care trusts will have information to help them place contracts with the best-performing providers.

But PROMs data will become available only through significant effort from the NHS. Technically, recording patients’ self-reported health status is not difficult; quality of life measures such as the so-called EQ-5D quality of life questionnaire and the Oxford hip and knee score (two of the recommended instruments) have been used for many years in clinical trials and other research where PROMs form part of a range of outcome measures. One question is how to get a decent sample (if not 100 per cent) when data will have to be collected before, during and after treatment. Collecting data post-discharge will be difficult and may need to involve GPs.

The next question is how data is to be linked to patients’ medical records for statistical, research and comparative purposes. PROMs data will have to be incorporated into medical records (and to become part of the national hospital episode statistics) to allow for comparisons between hospitals and consultants. This is also necessary for the next stage, which is to adjust PROMs data to allow for meaningful comparisons. It will be very important to take account of variations in the characteristics of patients. Getting the adjustment right will be imperative for the credibility of comparative PROMs in the eyes of clinicians.

The next big issue is not whether comparative PROMs data is published - the pressure to do so will be overwhelming - but dealing with public reaction to information that shows quality of care does vary between hospitals and clinicians.