The effectiveness of patient-reported outcome measures (PROMs) in improving the quality of care for patients undergoing hip replacement surgery

Abstract Background Competition-promoting reforms and economic incentives are increasingly being introduced worldwide to improve the performance of healthcare delivery. This study considers such a reform which was initiated in 2009 for elective hip replacement surgery in Stockholm, Sweden. The reform involved patient choice of provider, free establishment of new providers and a bundled payment model. The study aimed to examine its effects on hip replacement surgery quality as captured by patient reported outcome measures (PROMs) of health gain (as indicated by the EQ-5D index and a visual analogue scale (VAS)), pain reduction (VAS) and patient satisfaction (VAS) one and six years after the surgery. Methods Using patient-level data collected from multiple national registers, we applied a quasi-experimental research design. Data were collected for elective primary total hip replacements that were carried out between 2008 and 2012, and contain information on patient demography, the surgery and PROMs at baseline and at one- and six-years follow-up. In total, 36,627 observations were included in the analysis. First, entropy balancing was applied in order to reduce differences in observable characteristics between treatment groups. Second, difference-in-difference analyses were conducted to eliminate unobserved time-invariant differences between treatment groups and to estimate the causal treatment effects. Results The entropy balancing was successful in creating balance in all covariates between treatment groups. No significant effects of the reform were found on any of the included PROMs at one- and six-years follow-up. The sensitivity analyses showed that the results were robust. Conclusions Competition and bundled payment had no effects on the quality of hip replacement surgery as captured by post-surgery PROMs of health gain, pain reduction and patient satisfaction. The study provides important insights to the limited knowledge on the effects of competition and economic incentives on PROMs.

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Importance of patient reported outcome measures versus clinical outcomes for breast cancer patients evaluation on quality of care

The Breast ◽

10.1016/j.breast.2016.02.015 ◽

2016 ◽

Vol 27 ◽

pp. 62-68 ◽

Cited By ~ 13

Author(s):

Melissa Kool ◽

Joost R.M. van der Sijp ◽

Judith R. Kroep ◽

Gerrit-Jan Liefers ◽

Ilse Jannink ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Care ◽

Cancer Patients ◽

Clinical Outcomes ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Breast Cancer Patients ◽

Patient Reported

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Improving quality of care through patient-reported outcome measures (PROMs): expert interviews using the NHS PROMs Programme and the Swedish quality registers for knee and hip arthroplasty as examples

BMC Health Services Research ◽

10.1186/s12913-018-2898-z ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 18

Author(s):

Birgit Prodinger ◽

Paul Taylor

Keyword(s):

Quality Of Care ◽

Outcome Measures ◽

Hip Arthroplasty ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Expert Interviews ◽

Patient Reported ◽

Knee And Hip Arthroplasty

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Using Patient-Reported Outcome Measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney disease (PRO-trACK project): a mixed-methods project protocol

BMJ Open ◽

10.1136/bmjopen-2017-016687 ◽

2017 ◽

Vol 7 (6) ◽

pp. e016687 ◽

Cited By ~ 9

Author(s):

Olalekan Lee Aiyegbusi ◽

Derek Kyte ◽

Paul Cockwell ◽

Tom Marshall ◽

Mary Dutton ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Quality Of Care ◽

Mixed Methods ◽

Kidney Disease ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Advanced Chronic Kidney Disease ◽

Patient Reported

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Using patient-reported outcome measures (PROMs) to promote quality of care in the management of patients with established kidney disease requiring treatment with haemodialysis in the UK (PROM-HD): a qualitative study protocol

BMJ Open ◽

10.1136/bmjopen-2018-021532 ◽

2018 ◽

Vol 8 (10) ◽

pp. e021532 ◽

Cited By ~ 6

Author(s):

Nicola Elzabeth Anderson ◽

Melanie Calvert ◽

Paul Cockwell ◽

Mary Dutton ◽

Olalekan Lee Aiyegbusi ◽

...

Keyword(s):

Quality Of Care ◽

Kidney Disease ◽

Outcome Measures ◽

Clinical Care ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Routine Clinical Care ◽

Patient Reported ◽

The Uk

IntroductionPatients undergoing haemodialysis (HD) for end-stage kidney disease often report a poor quality of life (QoL) and identify that improving QoL has a higher priority for them than improvements in long-term survival. Research suggests that regular collection and usage of patient-reported outcome measures (PROMs) in patients with chronic conditions may reduce hospitalisation, improve QoL and overall survival. In the UK, despite increased use within research settings, PROMs have not been introduced into the routine clinical care for patients undergoing HD.We report the protocol for ‘Using patient reported outcome measures (PROMs) to promote quality of care in the management of patients with established kidney disease requiring treatment with haemodialysis in the UK—PROM-HD’. The study aim is to investigate the methodological basis for the use of routine PROMs assessment, particularly using electronic formats (ePROMs) within clinical and research settings, to maximise the potential of PROM use in the management of the care of this patient group.Methods and analysisThe project will use qualitative methodology to explore, by thematic analysis, the views, perceptions and experiences of patients receiving HD and members of the HD multidisciplinary team regarding the collection and use of PROMs in routine clinical care, particularly ePROMs. This will involve interviews with up to 30 patients or until saturation is achieved and three focus group sessions with approximately 18 members of the clinical team delivering care to this patient group, which will be interpreted broadly to include both professional and non-professional staff.

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Measurement of generic patient reported outcome measures (PROMs) in an acute admission unit: A feasibility study

Acute Medicine Journal ◽

10.52964/amja.0595 ◽

2016 ◽

Vol 15 (1) ◽

pp. 13-19

Author(s):

LS van Galen ◽

◽

W van der Schors ◽

NL Damen ◽

Mark H H Kramer ◽

...

Keyword(s):

Quality Of Care ◽

The Netherlands ◽

Outcome Measures ◽

Social Role ◽

Patient Reported Outcome Measures ◽

Tertiary Hospital ◽

Patient Reported Outcome ◽

Acute Admission ◽

Patient Reported

Objective: Measuring patient-reported outcome measures (PROMs) is a challenge in Acute Admission Units (AAUs), where patients present with a variety of pathologies. Generic PROMs may be used to measure the quality of care in this population. The main objective of this study was to assess the feasibility of measuring generic PROMs in a Dutch AAU. Design: Longitudinal cohort study Setting: An AAU of a tertiary hospital in Amsterdam, the Netherlands Participants: 123 patients admitted to the AAU during 5 weeks in May and June 2015 Methods: Patients admitted to the AAU were asked to fill out a questionnaire relating to three time points: 7 days before, during, and within 2 weeks after admission. Additionally, patients were asked to report on their experienced level of safety on the AAU and the contribution of the AAU to their recovery. Results: There were significant trends in generic PROMs for all three domains. Physical functioning decreased during hospital admission and almost fully returned to the previous level after discharge. Satisfaction with social role and anxiety significantly decreased over time. Conclusions: Measuring generic PROMs in the AAU is feasible. The analysis of the PROMs took little effort and results could be reported back to the healthcare workers on the AAU quickly. Patients appreciated being asked about their own perceived health and the quality of care. Given that this is the first study focusing on PROMs in AAU patients in the Netherlands, future studies with larger sample sizes, and from other nations are needed to further investigate PROMs in this patient group to establish International reference values.

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Assessing responsiveness of the EQ-5D-3L, the Oxford Hip Score, and the Oxford Knee Score in the NHS patient-reported outcome measures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02126-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sujin Kang

Keyword(s):

Outcome Measures ◽

Knee Replacement ◽

Oxford Knee Score ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Knee Score ◽

Paired Data ◽

Replacement Surgery ◽

Patient Reported ◽

Oxford Hip Score

Abstract Background The degree to which a validated instrument is able to detect clinically significant change over time is an important issue for the better management of hip or knee replacement surgery. This study examines the internal responsiveness of the EQ-5D-3L, the Oxford Hip Score (OHS), and the Oxford Knee Score (OKS) by various methods. Data from NHS patient-reported outcome measures (PROMs) linked to the Hospital Episodes Statistics (HES) dataset (2009–2015) was analysed for patients who underwent primary hip surgery (N = 181,424) and primary knee surgery (N = 191,379). Methods Paired data-specific univariate responsiveness was investigated using the standardized response mean (SRM), the standardized effect size (SES), and the responsiveness index (RI). Multivariate responsiveness was furthermore examined using the defined capacity of benefit score (i.e. paired data-specific MCID), adjusting baseline covariates such as age, gender, and comorbidities in the Box-Cox regression models. The observed and predicted percentages of patient improvement were examined both as a whole and by the patients' self-assessed transition level. Results The results showed that both the OHS and the OKS demonstrated great univariate and multivariate responsiveness. The percentages of the observed (predicted) total improvement were high: 51 (54)% in the OHS and 73 (58)% in OKS. The OHS and the OKS showed distinctive differences in improvement by the 3-level transition, i.e. a little better vs. about the same vs. a little worse. The univariate responsiveness of the EQ-5D-3L showed moderate effects in total by Cohen’s thresholds. The percentages of improvement in the EQ-5D-3L were moderate: 44 (48)% in the hip and 42 (44)% for the knee replacement population. Conclusions Distinctive percentage differences in patients’ perception of improvement were observed when the paired data-specific capacity of benefit score was applied to examine responsiveness. This is useful in clinical practice as rationale for access to surgery at the individual-patient level. This study shows the importance of analytic methods and instruments for investigation of the health status in hip and/or knee replacement surgery. The study finding also supports the idea of using a generic measure along with the disease-specific instruments in terms of cross-validation.

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