Despite all the data flowing around the NHS, the question of whether the patient feels better after a procedure is an extremely difficult one to answer. Some clinicians keep their own records, but more often than not they are interested only in whether what they did was successful from their perspective, not what benefit the patient perceived.
Tools have been developed to measure the patient's perspective - generally referred to as patient-reported outcome measures (PROMs). In the operating framework this year, the Department of Health announced that from April 2009 trusts will be required to collect PROMs for four conditions (hernia and varicose vein repairs and replacement of hips and knees), using a condition-specific measure and a generic measure.
The generic measure is the EQ-5D, which captures data on five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) as well as a single index scale with the extremes of "best imaginable health state" and "worst imaginable health state".
CHKS has been working for over a year with four acute trusts to build a normative database on this measure. Patients for all procedures have routinely been asked to complete a baseline EQ-5D at the point of admission and then a follow-up at three months.
So, at the simplest level do patients report feeling healthier after their procedure? The first graph (see below) shows the average index score of all patients, split out across four trusts. The trusts are ordered by the size of the change from baseline to follow-up (the value of which is given above the bars).
On the first graph we are looking at only a very restricted range of scores. Three of the four trusts show an improvement in the overall average, with one showing a decrease - but it also has the lowest baseline average. In fact, none of the trust's scores (both baseline and average) overlaps with the other trusts. So, are demographics having an effect?
The research literature shows that there are variations in the normal population for both sex and age. The next two graphs give the total profile for these NHS patients split by age and sex. They clearly demonstrate that there are striking differences - not surprisingly older people tend to report that they have a lower health status.
The first graph would be of interest to commissioners - but just think of the potential for patient choice for this sort of data by consultant (and procedure).