A half day workshop was run by the Primary Health Care Study Group in April on Patient Reported Outcome Measures (PROMs).
Mark Pennington, from London School of Hygiene and Tropical Medicine, presented a case study: Exploiting PROMs data in cost-effectiveness analysis. The case study assessed different technologies for total hip replacement: cemented, cementless and a hybrid of the two. To date, cementless is the most popular in UK and the US. Data from 30,000 patients were used to study the cost effectiveness and to compare the quality of life following the three prosthesis, in six sub groups stratified by gender and age. Genetic matching was used and did better than propensity score matching to control for case-mix. Follow up data was available at six months post-operation only but Markov models were used to extrapolate over patients’ lifetimes. The hybrid procedure was found to be the most cost effective and was associated with the best quality of life for the majority of patients, followed by the cemented approach, for which quality of life was the lowest.
The following talk was jointly presented by Stephen Tolan, from Arthritis Research UK, and Dafydd Richards, from NHS England, who introduced the tool Musculoskeletal-PROM. The NHS routinely captures PROMs for hip and knee joint replacement surgery. Existing generic and disease specific tools vary widely and there is no consistent way to collect outcomes centrally. They advocated that the attitudes and behaviours of all stakeholders involved in collecting, reporting and responding to patients’ reports need to change.
Arthritis Research UK is developing a generic M-PROM for the measurement of health status for a wide range of musculoskeletal disorders. The M-PROM will be multidimensional, applicable across health settings and not specific to any particular condition. It is intended to provide benchmarking opportunities, identify variations in care quality, and to produce patient data to inform future research. Its validity was challenged by several factors including the way attitudes to health change with age, different responses on repeated exposure to the same questionnaire, and the fact that many musculoskeletal disorders tend to improve with time, particularly if interventions were used at times of worst health.
The final talk by Jose (Chema) Valderas (Oxford University) addressed the assessment of PROMs. There are thousands of different PROMs, defined by the Food and Drug Administration as 'a measurement of any aspect of a patient’s health status that comes directly from the patient'. A few examples of PROMs were highlighted, including EQ5D and the Oxford Hip Score. Methods for the evaluation of the validity, reliability, responsiveness and administrative burden of these were introduced. Different tools are often used for evaluations and selecting the most appropriate one for a given purpose is challenging. Assessment of instruments may rely on the use of standard quantitative methods or other consensus based techniques. An example of the latter is COSMIN (the consensus-based standards for the selection of health measurement instruments) that developed a checklist containing standards for evaluating the methodological quality of measurement instrument studies.