The introduction of patient-reported outcome measures (PROMs) in the NHS in England in 2009 signalled a significant change of emphasis and a desire to measure the impact of health care interventions from the patient perspective.
The government's NHS white paper Equity and Excellence: Liberating the NHS (2010) states a clear ambition from the Department of Health that PROMs and PREMs (patient-reported experience measures) are utilised 'wherever practicable'.
Since then, PROMs and PREMs have increasingly been included by commissioners and service planners in specifications and have become routine as part of clinical governance and service redesign activity.
The Health and Care Professions Council (HCPC) reflect this evolving need for quality assurance in Standard 12 of the Standards of Proficiency for Physiotherapists (2013): '[Registrant physiotherapists must] be able to assure the quality of their practice'
This includes gathering qualitative and quantitative data, participating in audit activity, use of appropriate outcome measures and evaluation of interventions to ensure they meet the service users' needs and changes in health. All this is in the context of services across the UK continually needing to demonstrate their cost effectiveness and impact wherever possible.
The Chartered Society of Physiotherapy is therefore promoting a more standardised approach to outcome measurement and makes the following recommendations:
- The use of EQ-5D-5L as a standard generic PROM and Quality of Life (QoL) measure for all suitable specialties. EQ-5D-5L should be used in conjunction with the CSP's calculator tool by physiotherapists and their multidisciplinary team colleagues for all appropriate patients. see the EQ-5D-5L resources page
- The use of a disease specific PROM. This is a PROM that relates to a specific problem or condition and provides additional sensitivity to monitoring the patient. The CSP has been in discussion with several Professional Networks and has developed some consensus recommendations from them for several conditions see the disease-specific PROMs resources page
- The use of Patient Reported Experience Measures (PREMs). There are two types of patient questionnaires; functional and relational. Functional questionnaires ask about practical issues like experience of waiting times or the facilities available. Relational questionnaires ask about the patient’s experience of the treatment relationship such as whether they felt listened to or could take part in decision making. The CSP recommends a relational PREM called the CARE measure but other PREMs are also available.
How do you use PROMs and PREMs in routine physiotherapy practice?
- Typically, PROMs are collected at the start and at some point after the end of treatment (although some self-monitoring PROMs may exist for long term conditions). PREMs are usually collected after an episode of treatment or interventions. Below are some tips which you may find useful to implement routine outcome measurement in the team:
- Seek team engagement – consult your staff and make sure to highlight the role PROMs and PREMs can have for patients, service evaluation and reporting to managers and commissioners
- Identify a small project team to facilitate the implementation process
- Plan opportunities to regularly feedback team performance in relation to outcome measurement
- Ensure any data collected is used.