Report from Tim Benson Abies Ltd
Trafford General Hospital 18 July 2013
Organiser Bibhas Roy, consultant shoulder surgeon
Slogan: PROMS 2.0 Measuring Care
Welcome from Simon Musgrave, clinical director. Trafford Hospital is noew part of Central Manchester University Hospitals, which is a large foundation trust running 6 hospitals (£800M pa). Trafford will become focused on Orthopaedics, day surgery etc. Local support for PROMs - historically we have all spent too little time on patient interests.
Bibhas Roy description of PROMS2.0 project. Got about £25k from regional innovation fund, but also access to junior staff. Aim is to collect data into meaningful information. Practice based evidence is what really matters. Nice demo of his PROMs 2.0 system, message based on result for patient. See also video at http://proms2.org/. Importance of process mapping. Complex pathways. 14 organisations now using PROMs 2.0, but not much progress in past 12 months. Keen to use this meeting to step forward. Problem of lack of attention to human elements of changing behaviour among professionals. Aim to minimise risks of patients "doing the wrong thing" based on PROMs feedback. Difficulty of negotiation with national PROMs suppliers, so National PROMs and PROMS2 are distinct.
Very effective patient participation and feedback to meeting (articulate patient). Very important to have at least one patient participate in meeting. Useful for family to see how I am doing. Did it in Egypt on holiday! But system down one day. Able to give up physio before end of course with agreement all round. Able to learn what to do when second shoulder was done! Save on hospital checkup visits. Now feel in control. Everyone now has a computer. Physio also has access to PROMs 2.0 so knows my progress.
Suzanne.Skevington@manchester.ac.uk. Manchester centre for health psychology. WHOQOL-BREF general survey tool for QoL. More than 80 language versions. Takes about 6 minutes. 26 questions. Problems of cross-cultural translation. Use of spoke wheel methodology for simultaneous translation. Domains and Facets: 25 definitions. See Saxena eg al 2001. Skevington 2004, Diehr 2006, Skevington 2011
My own presentation went down well, although I crashed my computer just before talk! Passed round ipad. Suggestion from patient that we ask howRU before appointment to share with clinicians, and use howRwe and FFT after seeing people. Also fill it in when doing other routine transactions, such as ordering repeat scripts, checking in for surgery appointments etc.
Jane Stairmand improving outcomes manager, NE Cheshire CCG. Use in LTCs for pulmonary rehab. Use of PROMs2.0. Took too long. Some patients had inadequate IT. Patients liked seeing their own scores and that they could spend appointment time discussing their needs, not their history. Need for quicker means of patient log in. Use slick pathway to do this.
Adele Whitman evaluation of patient satisfaction using PROMs2. For ASAD shoulder operation. Used OSS, EQ5D, PPE-15 and recommend system to friend. Designed score-related pathway. 94% of patients would be happy to be discharged at 2 weeks.
PROMs in mental health. Asad Satiq. Problem in psychiatry is that there are no objective outcome measures at all. We only have what the patient tells us. Psychiatrists want to know if they are doing any good. Typical caseload 450 patients seen every 6 months. Mostly well but patients may be up and down a lot in between. Medication can cause harm (dependence). Use PROMs to guide service delivery. Pilot 4 consultants and home treatment team. Needs clinical champion. Used 2 iPads. IG problems. Hard to sell to team. Train everyone separately. Sort out logins, ensure security, go with staff on initial home visit. Explain it as part of care pathway. Provide email with PROMs link at 4, 8 and 12 weeks. Use of volunteers. Regional innovation grants relatively easy to get for NHS people- impossible for outsiders.
Samantha Riley Director of Insight NHS England. FFT, Annual Surveys, PROMs. National role to spread good practice. Clear differences between Bibhas' PROMs 2 approach and the National programme. Not likely to throw out what is done now. But do want to investigate if there new ways to do things and find out how best to help. There is no new money right now, but she hopes to get some.
TB question about why it costs extra to get raw PROMS data. Samantha Riley and David Glover said they would look at it. TB. Practice-based evidence. Bribe hospitals to evaluate different ideas. CQUINs are one way.
Amir Hannan. Recognise that PROMs are critical for commissioning.
Specifics: genuine interest in the Trust. NHS England is key. Focus on patient experience is relatively easy compared with outcomes. Going beyond FFT. failure in transfer.
Actions: .NHS England have 2-day meeting to focus on PROMs next week. I spoke to David Glover who is now becoming art of that team. Newly appointed manager, responsible to Samantha Riley.
Amir Hannan is now director responsible for LTCs at Thameside. Keen to collaborate.
Summary of lessons:
1. Bibhas is very keen to do something at scale in Trafford, but needs to use his platform. Real poitical and clinical buy-in at the Trust. Keen to collaborate.
2. He has made valuable contribution in integrating PROMs and PREMs into pathway of routine care, and using results to impact repeat appointments etc. Sensitively done, patient is always offered options (e.g. offered option of discharge from coming to further follow-up appointments, not discharged).
3. Manchester is becoming a modest but ambitious centre of innovation in this area, with people like Bibhas, Iain Buchan, Suzanne Skevington, Amir Hannan all collaborating.
4. Need for more practice-based evidence.
· Sara Kavanagh Clinical Standards Department | Royal College of Physicians