The 2013 British Elbow & Shoulder Society meeting saw a presentation from Trafford. The PROMs 2.0 system had been used to give patients an option of not returning to clinic if they were doing well following surgery.
This paper was a prize winner - see the full presentation here
Capturing outcome data is a fundamental step in advancing the quality and benefits of surgical care. Collecting this information over the whole UK population with different technological abilities and cultural diversity is a formidable challenge.
Patients attend a number of review clinic appointments following a surgical procedure. Many of these patients will be progressing well and improving as anticipated. Patients may feel that they are doing well and that extra clinic appointments add no value to their care but require some reassurance that they are improving as expected. Can we give patients clear information about their progress and offer them choice regarding their post-surgical care?
The PROMs 2.0 innovation solution facilitates the collection of validated outcome measures following surgery. This information is presented to patients and clinicians in a form they can understand and use. This new, multi-format patient communication system liberates patient rated outcome measures (PROMs) from distant, academic research applications to give patients accurate and relevant information about their progress following a procedure. This information is used to target individuals who need to be reviewed in clinic and can reduce unnecessary clinic attendances.
PROMs 2.0 is a web-based application, developed by clinicians in collaboration with Bluespier International, developer of clinical information systems. The design allows hospital patient administration systems to link in and can integrate Hospital Episode Statistics (HES) data. PROMs 2.0 expands the narrow focus of the current national PROMs collection from just four procedures to any intervention where a validated PROM can be applied. The system will collate information from these multiple sources for risk adjustment to be performed to allow fair comparison of different institutions with different population characteristics. This will include information such as severity of disease, co-morbidities, smoking status etc.
Clinicians can customise the system according to their individual practice. Patients listed for surgery are entered onto the secure database and a set of pre and post-op PROM assessments are generated. Automatic e-mail links are sent or phone calls made to each patient at pre-determined time points. Patients can compare their current, previous and pre-op scores and can see average scores for their specific procedure. This valuable information is also available to the treating clinician in the office or in clinic. A letter is automatically created with the outcome information and sent to the patients GP.
Where a patient’s score is satisfactory, they are reassured about good progress and can choose to avoid an unnecessary clinic visit. However, if they wish to be seen, this is organised as usual. Where a score is not satisfactory, the patient is informed of the result and a review clinic appointment is arranged to check for any problems. The system captures data about the quality of the intervention and also allows comparison of results between various groups i.e. clinicians, providers, subgroup of patients etc.
This system combines broad access with adaptability and automation to improve clarity and communication with patients and to focus resources where clinical need exists. This system can gather outcome data via e-mail, phone, and mail or directly in clinic and therefore can be used with patients of all levels of communication and technical ability. The software can be adapted to use any PROM and activate at any specified time points for any intervention. Once patient details are entered, assessments and GP documents are automatically generated, reducing the burden of administration. Patients and clinicians get a clear measure of quality of intervention, complementing their post surgical care and adding value to the service. In addition, unnecessary clinic visits can be avoided. The other major aspect of this innovation is in the fact that it allows real time comparative analysis of the quality of intervention based on organisation, clinician, specific patient groups etc.
A health innovation grant of £20,000 from the SHA has enabled development of the initial pilot software development with Bluespier. Refinements and improvements have been made through the collaboration of clinicians, patients, designers, administrators and independent evaluation of Liverpool John Moores University. The project has attracted further funding and PROMs 2.0 is being implemented in 9 trusts across the North West region, with the ambition of including more organisations across the country.
The automated system uses the only free resource in the NHS, the patient, to measure quality of interventions. Cost savings and increased productivity are facilitated by the reduced number of patients returning to outpatient clinics for unnecessary review appointments.
The PROMs 2.0 project carries truly huge potential. This system can be applied to every specialty across the whole NHS. There is even potential for this system to be adopted in other countries, as outcome measurement is essential in healthcare worldwide. We estimate that post-procedure follow up appointments will be reduced by one third, by only seeing patients who need to be seen. These savings can not only absorb the costs of running the system, but result in significant savings.