Analysis of Patient Reported Outcomes Measures

Transcription

1 Analysis of Patient Reported Outcomes Measures Pre-Operative Health Status Data April 2009 to March 2010 Commissioning Analysis and Intelligence & System Management and New Enterprise

2 DH Information Reader Box DH INFORMATION READER BOX Policy HR / Workforce Management Planning / Clinical Document Purpose Gateway Reference Title Author Publication Date Target Audience Circulation List For Information Estates Commissioning IM & T Finance Social Care / Partnership Working Analysis of Patient Reported Outcome Measures (PROMs) DH, Commissioning & System Management, Commissioning Analysis & Intelligence 02 Jun 2011 PCT CEs, Medical Directors, Directors of PH, Directors of Finance #VALUE! DH INFORMATION READER BOX Description Cross Ref Superseded Docs Action Required Timing Contact Details This document contains analysis to help commissioners use Patient Reported Outcome Measures (PROMS) for heath investment decisions. PROMS are collected for 4 procedures: hip and knee replacements, groin hernia and varicose veins. The analysis, and accompanying tool, enable commissioners to examine the relationship between a range of factors at local level: pre-operative health status, post-operative health status, activity volumes, expenditure, and demographic factors (age, sex and deprivation). Using the tool, commissioners will be able to identify their current position and relative position to any national trend. This will help them understand their current outcomes and may prompt issues to investigate further leading to improved outcomes and health investment decisions. None for commissioners None N/A None Bryn Shorney Commissioning Analysis and Intelligence Room 2E47, Quarry House Quarry Hill, Leeds LS2 7UE For Recipient's Use 2

3 Overview of key findings This pack presents analysis of Patient Reported Outcomes Measures (PROMs). The main focus is on pre-treatment health status data. The pack highlights the variation between patients health status and between the average health status for different procedures; Groin Hernia and Varicose Veins patients have much higher pre-treatment health status than Hip and Knee Replacement patients A quarter of Groin Hernia patients report no problems on all five dimensions of care A fifth of Varicose Vein patients report no problems on all five dimensions of care 99% of Hip and Knee Replacements patients report some or severe problems of discomfort More patients have lower pre-treatment health status and have fewer procedures than less patients For each intervention there is large variation in average pre-treatment health status across PCTs Hip and Knee Replacement patients have much higher health gains than Groin Hernia and Varicose Vein patients. Further work will be undertaken to investigate Post-Operative data in more detail. The PROMPT benchmarking tool allows commissioners to investigate this information in more detail through a range of interactive charts 3

4 Contents 1) About Patient Reported Outcomes Measure 2) Key information 3) Detailed procedure level information 4) Post-treatment health status and health gain information 5) Next steps 6) Summary 4

5 About Patient Reported Outcomes Measures 5

6 About Patient Reported Outcomes Measures PROMs provide a patient reported assessment of health, often expressed as a single number. Change in PROMs scores as a result of surgery are a measure of outcomes. All providers of NHS-funded hip and knee replacements, groin hernia and varicose vein surgeries have been required to collect and report PROMs since 1 st April The programme covers nearly 1bn of expenditure and collection of these data for a whole healthcare system is a world-first. Pre-operative PROMs data published for the first time April 2010, supplemented with monthly publications. The data are currently classed as experimental statistics initial findings to be presented for discussion and further investigation; information on data coverage and quality to be made available to encourage local action to improve these areas; users to comment on methodology and their needs for analysis. Data has been linked with Hospital Episode Statistics (HES) episode-level information, which provides information on patient characteristics, e.g. age and sex 6

7 Key information 7

8 The average pre-treatment health status reported by patients varies across different procedures Patients undergoing Knee and Hip Replacements have much lower pretreatment health status than patients undergoing Groin Hernia and Varicose Vein procedures Males report higher average pre-treatment health status than females for all procedures Procedure Group Groin Hernia (G H) Varicose Vein (V V) Knee Replacement Hip Replacement Average pretreatment health status (EQ-5D Index) Average pretreatment health status (EQ-5D Index) - Males Average pretreatment health status (EQ-5D Index) - Females A patient in full health would have a EQ-5D Index score equal to Number of linked questionnaires 25,073 11,477 30, ,924 Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March 2010 This analysis covers approximately 40% of all procedures, as there is a 60% response rate to questionnaires and 68% of returned questionnaires are successfully linked to HES data to allow analysis of patient characteristics Confidence levels (95% throughout) are of the order 0.01 or less for the above pre-treatment health status (EQ-5D Index) 8

9 Pre-treatment health status varies with deprivation level of patients Knee Replacement - Pre-treatment health status by deprivation band Hip Replacement - Pre-treatment health status by deprivation band EQ-5D Index Most 10% More 10-20% More 20-30% More 30-40% More 40-50% Pre-treatment health status (EQ-5D) G H Less 40-50% V V Less 30-40% Less 20-30% Knee Less 10-20% Hip Most 10% More 10-20% More 20-30% More 30-40% More 40-50% Less 40-50% Less 30-40% Less 20-30% Less 10-20% Least 10% Least 10% EQ-5D Index Most 10% More 10-20% More 20-30% More 30-40% More 40-50% Less 40-50% Less 30-40% Less 20-30% More patients have lower pretreatment health status for all procedures For Knee Replacements, the average pretreatment health status of the most 10% of patients is 0.30 compared to 0.46 for the least 10% For Hip Replacements, the average pretreatment health status of the most 10% of patients is 0.24 compared to 0.40 for the least 10% A patient in full health would have a EQ-5D Index score equal to 1 Less 10-20% Least 10% Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

10 Number of procedures also varies with deprivation level of patients More patients have fewer procedures than less patients for Groin Hernia and Knee and Hip Replacements The most 10% of patients have less than half the number of procedures of the least 10% of patients for Hip Replacements Less patients have fewer Varicose Vein procedures than more patients Note: Based on number of linked questionnaires not total number of procedures Number of procedures Knee Hip Most 10% 1,879 1,385 More 10-20% 2,301 1,706 More 20-30% 2,721 2,071 More 30-40% 2,909 2,493 More 40-50% 3,235 2,924 Less 40-50% 3,233 2,957 Less 30-40% 3,343 3,330 Less 20-30% 3,266 3,146 Less 10-20% 3,192 3,112 Least 10% 2,760 2,966 Index EQ-5D Most 10% No. of Linked Episodes Most 10% More 10-20% More 20-30% More 30-40% Pre-treatment health status and number of procedures for Groin Hernia Patients More 10-20% Average EQ-5D Index Number of Procedures More 20-30% More 30-40% More 40-50% Less 30-40% Less 40-50% More 40-50% Less 40-50% Less 30-40% Less 20-30% Less 10-20% Least 10% Groin Hernia Knee Replacement Hip Replacement Varicose Vein Less 10-20% Less 20-30% Least 10% 3,000 2,500 2,000 1,500 1, Number of Procedures Number of procedures and pretreatment health status both increase as deprivation levels fall for Groin Hernia patients A patient in full health would have a EQ-5D Index score equal to 1 Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

11 Pre-treatment health status also varies with age of patients Hip Replacement pre-treatment health status by age band Knee Replacement pre-treatment health status by age band EQ-5D Index Age Bands A patient in full health would have a EQ-5D Index score equal to 1 Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March 2010 Patients aged 62 to 76 have the highest pre-treatment health status for Hip Replacements Patients aged 22 to 36 and aged over 87 have the lowest pre-treatment health status for Hip Replacements Patients aged 67 to 86 have the highest pre-treatment health status for Knee Replacements Patients aged 32 to 46 and aged over 92 have the lowest pre-treatment health status for Knee Replacements EQ-5D Index Age Bands 11

12 Number of procedures also varies with age of patients Procedure Group Average Age 1 Number of Linked Episodes Knee and Hip Replacement patients are on average older than Groin Hernia and Varicose Vein patients Groin Hernia Knee Replacement Hip Replacement Varicose Vein < Groin Hernia 58 Varicose Vein 50 Knee Replacement Hip Replacement 68 8,445 (30%) of Hip Replacements patients are aged 75 or over and 3,865 (14%) are aged 80 or over 9,444 (31%) of Knee Replacements patients are aged 75 or over and 4,223 (14%) are aged 80 or over 1 Average age of patients completing questionnaires Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

13 Detailed procedure level information 13

14 Groin Hernia: PCT Level variation in pre-treatment health status 30 PCTs with lowest EQ-5D Index Next 31 PCTs Next 30 PCTs Next 31 PCTs 30 PCTs with highest EQ-5D Index Mean EQ-5D Index Score <-Worst Health Outcome - Best Health Outcome-> Groin Hernia - Mean EQ-5D Index Scores Average pre-treatment health status for Groin Hernia patients ranges from 0.68 to 0.84 at PCT level PCT Rural and less PCTs have higher average pre-treatment health status A patient in full health would have a EQ-5D Index score equal to 1 Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

15 Groin Hernia: Pre-treatment health status broken down by five dimensions of care The majority of Groin Hernia patients report no problems on Mobility, Self-care, Activity and Anxiety The majority of Groin Hernia patients report some problems of Pain/Discomfort prior to treatment EQ-5D patient reported outcome questionnaire has five dimensions; Mobility, Self-Care, Activity, Discomfort and Anxiety Percentage of patients reporting no problems Mobility Selfcare Activity Pain/ Discomfort Anxiety 78% 95% 69% 32% 82% Over a quarter of Groin Hernia patients report no problems on all the dimensions prior to treatment No Problems all dimensions 26.1% Some Problems all dimensions 0.8% Severe Problems all dimensions 0.0% Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

16 Varicose Vein: PCT Level variation in pre-treatment health status 30 PCTs with lowest EQ-5D Index Next 31 PCTs Next 30 PCTs Next 31 PCTs 30 PCTs with highest EQ-5D Index Mean EQ-5D Index Score <-Worst Health Outcome - Best Health Outcome-> Varicose Vein - Mean EQ-5D Index Scores PCT Average pre-treatment health status for Varicose Vein patients ranges from 0.46 to 0.86 at PCT level A patient in full health would have a EQ-5D Index score equal to 1 Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

17 Varicose Vein: Pre-treatment health status broken down by five dimensions of care Scores (%) The majority of Varicose Vein patients report no problems on Mobility, Self-care, Activity and Anxiety The majority of Varicose Vein patients report some problems of Pain/Discomfort prior to treatment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Varicose Veins Mobility Self-care Activity Discomfort Anxiety EQ-5D Index Dimensions No Problems Some Problems Unable to Perform EQ-5D patient reported outcome questionnaire has five dimensions; Mobility, Self-Care, Activity, Discomfort and Anxiety Percentage of patients reporting no problems Mobility Selfcare Activity Pain/ Discomfort Anxiety 75% 95% 73% 25% 75% Over a fifth of Varicose Vein patients report no problems on all the dimensions prior to treatment No Problems all dimensions 20.3% Some Problems all dimensions 0.6% Severe Problems all dimensions 0.0% Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

18 The Aberdeen Varicose Vein Questionnaire provides information on pre-treatment health status that is more specific to Varicose Vein patients Scores (%) The majority of Varicose Vein patients reported that they did not need to take painkillers or suffer swelling in the two weeks prior to treatment The majority of Varicose Vein patients also reported that their condition did not have any effect on leisure or work/housework/other daily activities in the two weeks prior to treatment However, Varicose Vein patients reported their condition caused concern and influenced choice of clothing 80% 70% 60% 50% 40% 30% 20% No Ocassionally/some difficulty Often/Moderate difficulty Always/servere difficulty/more than 1 day Dimension Pain-killers Swelling Concern Percentage of patients reporting no problems in two weeks prior to treatment 72% 53% 13% 10% 0% Pain-Killer Days Swelling Concern Clothing Work Leisure Dimensions Clothing Work/Housework 27% 64% Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March 2010 Leisure 52% 18

19 Knee Replacement: PCT Level variation in pre-treatment health status 30 PCTs with lowest EQ-5D Index Next 31 PCTs Next 30 PCTs Next 31 PCTs 30 PCTs with highest EQ-5D Index Mean EQ-5D Index Score <-Worst Health Outcome - Best Health Outcome-> Knee Replacement - Mean EQ-5D Index Scores Average pre-treatment health status for Knee Replacement patients ranges from 0.15 to 0.51 at PCT level PCT Rural and less PCTs have higher average pre-treatment health status A patient in full health would have a EQ-5D Index score equal to 1 Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

20 Knee Replacement: Pre-treatment health status broken down by five dimensions of care Scores (%) Only 1% of Knee Replacement patients report no Pain/Discomfort. 57% report some Pain/Discomfort and 39% severe Pain/Discomfort The majority of Knee Replacement patients report some problems on Mobility and Activity but no problems on Self-care or Anxiety EQ-5D patient reported outcome questionnaire has five dimensions; Mobility, Self-Care, Activity, Discomfort and Anxiety 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Knee Replacement Mobility Self-care Activity Discomfort Anxiety EQ-5DDimension No Problems Some Problems Unable to perform Percentage of patients reporting no problems Percentage of patients reporting some problems Percentage of patients reporting severe problems Mobility Selfcare Activity Pain/ Discomfort Anxiety 6% 66% 9% 1% 59% 92% 31% 74% 57% 34% 0.4% 1% 15% 39% 4% Only 0.3% of Knee Replacement patients report no problems on all the dimensions prior to treatment Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

21 The Oxford Knee Replacement Questionnaire provides information on pre-treatment health status that is more specific to Knee Replacement patients 94% of Knee Replacement patients reported extreme pain and 61% reported extreme pain in bed at night in the four weeks prior to treatment 1 Only 0.3% of Knee Replacement patients reported no pain in the four weeks prior to treatment 30% of Knee Replacements patients reported extreme difficulty walking and 49% reported extreme difficulty standing up in the four weeks prior to treatment 1 Score Percentage (%) 60% 50% 40% 30% 20% 1 Extreme difficulty/pain or worse outcome/unable to perform Worst Outcome - Unable to perform activity Ext reme Dif fcult y/ Pain M oderate Difficulty/Pain Little Difficulty/Slight Pain No Difficulty/Pain 10% 0% Pain Night Pain Washing Transport Walking Standing Limping Kneeling Work Confidence Shopping Stairs OKR Dim e ns ions Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

22 Hip Replacement: PCT Level variation in pre-treatment health status 30 PCTs with lowest EQ-5D Index Next 31 PCTs Next 30 PCTs Next 31 PCTs 30 PCTs with highest EQ-5D Index Mean EQ-5D Index Score <-Worst Health Outcome - Best Health Outcome-> Hip Replacement - Mean EQ-5D Index Scores Average pre-treatment health status for Hip Replacement patients ranges from 0.19 to 0.45 at PCT level PCT Rural and less PCTs have higher average pre-treatment health status A patient in full health would have a EQ-5D Index score equal to 1 Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

23 Hip Replacement: Pre-treatment health status broken down by five dimensions of care Only 1% of Hip Replacement patients report no Pain/Discomfort. 54% report some Pain/Discomfort and 42% severe Pain/Discomfort The majority of Hip Replacement patients report some problems on Mobility, Self-care and Activity EQ-5D patient reported outcome questionnaire has five dimensions; Mobility, Self-Care, Activity, Discomfort and Anxiety Scores (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Hip Replacement Mobility Self-care Activity Discomfort Anxiety EQ-5DDimensions No Problems Some Problems Unable to Perform Percentage of patients reporting no problems Percentage of patients reporting some problems Percentage of patients reporting severe probelms Only 0.3% of Hip Replacement patients report no problems on all the dimensions prior to treatment Mobility Selfcare Activity Pain/ Discomfort Anxiety 6% 43% 6% 1% 55% 91% 53% 71% 54% 37% 1% 2% 21% 42% 5% Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

24 The Oxford Hip Replacement Questionnaire provides information on pre-treatment health status that is more specific to Hip Replacement patients 93% of Hip Replacement patients reported extreme pain and 69% reported extreme pain in bed at night in the four weeks prior to treatment 1 Only 0.5% of Hip Replacement patients reported no pain in the four weeks prior to treatment 36% of Hip Replacements patients reported extreme difficulty walking and 48% reported extreme difficulty standing up in the four weeks prior to treatment 1 1 Extreme difficulty/pain or worse outcome/unable to perform Oxford Hip Replacement Scores OHR Dimensions 60% 50% 40% 30% 20% Unable to perform activity Extreme Diffculty/Pain Moderate Difficulty/Pain Little Difficulty/Slight Pain No Difficulty/Pain 10% 0% Pain Sudden Pain Night Pain Washing Transport Dressing Shopping Walking Limping Stairs Standing Work Scores (%) Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

25 Preliminary Analysis of post-treatment health status and health gain information 25

26 Preliminary analysis shows the average post-treatment health gain reported by patients varies across different procedures and PCTs future work will investigate health gain information in more detail Case-mix adjusted health gain National Average Groin Hernia 0.08 Varicose Vein Knee Replacement Lowest PCT Average Highest PCT Average Hip Replacement A patient in full health would have a EQ-5D Index score equal to 1 Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March 2010 Knee and Hip Replacement patients report much higher post-treatment health gain than Groin Hernia and Varicose Vein patients Case-mix adjusted health gain information takes account of patient characteristics. An unadjusted health gain is also available this is simply the difference between post-treatment health status and pre-treatment health status The health gain information does not take account of whether patients health status would have deteriorated further from pre-treatment levels i.e. this does not pick up whether treatment has prevented patients getting worse 26

27 Next Steps 27

28 Proposed Next Steps Further development of benchmarking tool Further work on post-treatment health status and health gains - What is the relationship between pre-treatment and post-treatment health status? - What other factors effect health gains? Feedback from the NHS on what further work should be undertaken is welcome 28

29 Summary 29

30 Summary Analysis of Patient Reported Outcomes Measures shows; Groin Hernia and Varicose Veins patients have much higher pre-treatment health status than Hip and Knee Replacement patients A quarter of Groin Hernia patients report no problems on all five dimensions of care A fifth of Varicose Vein patients report no problems on all five dimensions of care 99% of Hip and Knee Replacements patients report some or severe problems of discomfort More patients have lower pre-treatment health status and have fewer procedures than less patients There is large variation in average pre-treatment health status across PCTs Hip and Knee Replacement patients have much higher health gains than Groin Hernia and Varicose Vein patients further work is required to explore health gains information in more detail The PROMPT benchmarking tool allows commissioners to investigate this information in more detail through a range of interactive charts 30

31 Annex 31

32 Further details of PROMs Questionnaires PROMs questionnaires combine 2 types of measures to maximise impact of collected data Procedure Condition-specific Generic Unilateral Hip Replacement Oxford Hip Score EQ-5D* Unilateral Knee Replacement Oxford Knee Score EQ-5D* Groin Hernia Surgery None EQ-5D* Varicose Vein Surgery More sensitive tool for intraprocedure comparisons; often more familiar to clinicians e.g. OHS / OKS Aberdeen Varicose Vein Questionnaire Robust tool for health economic analysis, and comparison across procedures; Recommended by NICE EQ-5D* *: EQ-5D TM is a trademark of the EuroQol Group ( 32

33 The average pre-treatment health status reported by patients on condition specific measures varies across different procedures Males report higher average pre-treatment health status than females for all procedures Procedure Group Varicose Vein (Aberdeen Varicose Vein Score) Best Health Status = 0 Worst Health Status = 100 Knee Replacement (Oxford Knee Score) Best Health Status = 48 Worst Health Status = 0 Hip Replacement (Oxford Hip Score) Best Health Status = 48 Worst Health Status = 0 Average pretreatment health status 19.1 (0.19) 18.4 (0.09) 17.8 (0.10) Average pretreatment health status - Males 17.5 (0.34) 20.4 (0.13) 19.3 (0.16) Average pretreatment health status - Females 20.0 (0.23) 16.9 (0.11) 16.9 (0.13) Confidence intervals at 95% level in brackets Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

34 The average pre-treatment health status reported by patients varies across different procedures Males report higher average pre-treatment health status than females for all procedures Procedure Group Varicose Vein (Aberdeen Varicose Vein Score) Best Health Status = 0 Worst Health Status = 100 Knee Replacement (Oxford Knee Score) Best Health Status = 48 Worst Health Status = 0 Hip Replacement (Oxford Hip Score) Best Health Status = 48 Worst Health Status = 0 Average pretreatment health status Average score of PCT with worst pre-treatment health status Average score of PCT with best pre-treatment health status Source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care, Provisional Data, April 2009 to March

35 Useful links HES Online Access the latest PROMs data &categoryid=1295 DH website Guidance and information on PROMs ationspolicyandguidance/dh_ The King s Fund Getting the most from PROMs 35

36 Further Information For queries or further information please contact the Health Investment Network mail box: For a comprehensive range of resources to support commissioners make better health investment decisions click on the following: 36