Patient survey suggests benefit from common procedures varies markedly by NHS provider

- Comparative annual PROMs results published for first time

15 August 2012

*Regional information available from this report

The level of health benefit patients feel they gain from common procedures varies markedly between NHS providers, results from a patient survey suggest.

Final 2009-10 and 2010-11 results of Patient Reported Outcome Measures (PROMs) surveys in England are today published together for the first time by the Health and Social Care Information Centre (HSCIC); allowing the first ever year-on-year comparison.

They paint a picture of very little change in national scores and continued variation by provider in relation to hip, knee, varicose vein and groin hernia procedures (the four procedures in the PROMs programme).

Patients complete PROMs surveys about their health before and after surgery, with the difference between the two indicating how much or little they feel they have gained. Five different scoring systems are used; of which three are condition specific and two apply across all four procedures. The more detailed of these two - the EQ-5D Index score – captures the impact of treatment on a range of aspects of general health such as mobility, self-care, pain and depression.

Using the EQ-5D Index score to compare results across all four procedures, the report shows that in 2010/11:

Hip replacements

• Nationally, 86.7 per cent of respondents recorded an improvement in general health after surgery, compared to 87.2 per cent of respondents in 2009/10.
• Five healthcare providers were positive outliers (meaning their scores were significantly better than expected) compared to three in 2009/10.
• Two providers – Shepton Mallet NHS Treatment Centre, Somerset; and the Horder Centre, East Sussex were positive outliers in both years; the only two providers to feature in this category in both years for any of the four procedures.

• Nine providers were negative outliers (meaning their scores were significantly worse than expected) compared to zero in 2009/10. No provider was a negative outlier in both years for this or any of the other three procedures.

Knee replacements

• Nationally overall, 77.9 per cent of respondents recorded an improvement in general health after surgery, compared to 77.6 per cent of respondents in 2009/10.
• One provider was a positive outlier compared to two in 2009/10; while six were negative outliers compared to three in 2009/10.

Groin hernia surgery

• Nationally overall, 50.5 per cent of respondents recorded an improvement in general health after surgery, compared to 49.3 per cent of respondents in 2009/10.
• One provider was a negative outlier in 2010/11, but there were no other outliers (positive or negative) identified in either year.

Varicose Vein surgery

• Nationally overall, 51.6 per cent of respondents recorded an improvement in general health after surgery, compared to 52.4 per cent of respondents in 2009/10.
• There were no positive or negative outliers among providers in 2010/11; while in 2009/10 there were no positive outliers and two negative outliers.

The PROMS participation rate rose to nearly 70 per cent in 2010/11 compared to just over 66 per cent in the previous year. In total, 171,500 pre-operative questionnaires were completed in relation to 245,500 eligible procedures (compared to 158,300 pre-operative questionnaires for 239,700 eligible procedures in 2009/10).

Provisional data for 2011/12 has also been published today; this data is provisional as there is still time for further patient questionnaires to be returned and analysed before the dataset is finalised.

HSCIC chief executive Tim Straughan said: “The importance of patient survey information to the NHS has been made clear in recent years; and today’s figures represent a significant step in being able to gain a clear understanding on how people personally feel about their health after common procedures like knee and hip replacements and how this has changed in time.

“Patients and health professionals alike will have great interest in today’s results– which offer an unprecedented two year insight of not just the nuts and bolts of NHS activity, but the viewpoint of people who have experienced these procedures.”

The report is at: http://www.ic.nhs.uk/pubs/finalisedproms1112

ENDS

Notes to editors

1. HSCIC was previously known as the NHS Information Centre. It is England’s authoritative, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The HSCIC also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
2. Before a patient undergoes one of the four PROMs procedures, the provider should offer the patient a pre-operative PROMs questionnaire for completion between the patient being passed fit for surgery and the treatment taking place. Completion of the PROMs questionnaire is voluntary for the patient and their consent to participate must be granted for the data to be processed and used.
3. Post-operative questionnaires are sent out to patients three months (for groin hernia and varicose vein surgery) or six months (for hip and knee replacement surgery) after the procedure date recorded on their hospital record. If the pre-operative questionnaire is not linked to a hospital episode and the procedure data is not available, the three- or six-month count is started 12 weeks after the scan date of the pre-operative questionnaire. The patient can then return the questionnaire at any time thereafter.
4. Analysis is of pre- and post-operative questionnaire pairs where the pre-operative questionnaire was completed between 01 April 2010 and 31 March 2011 and the post-operative questionnaire was linked to an eligible pre-operative questionnaire and sent out to a patient, returned and scanned prior to the end of June 2012.
5. Healthcare providers which are ‘outliers’ have been identified by a statistical model as having outcomes significantly different from the national average. A ‘positive outlier’ has a significantly better outcome than expected; a ‘negative outlier’ significantly worse. The outlier model is based on statistical theory and is not a declaration of the provider doing anything ‘wrong’ or ‘right’; in particular there is a roughly 1 in 500 chance that a provider would be identified by the model as an outlier merely because of random variation amongst the patients they treat.
6. The PROMs programme utilises a number of tested and well-established methodologies to enable patients to rate their health status before and after their operation.
7. The EQ-5D Index score reflects general health status, capturing condition specific issues in a broad way through five weighted questions. This measure is more disaggregated than the alternative EQ-VAS score.
8. The EQ-VAS score asks patients to score their health on a scale of 0 (worse) to 100 (better) on the day that they complete the questionnaire and therefore provides an indication of the patient's health that may not necessarily be associated with the condition for which they underwent surgery and may be affected by factors other than health care.
9. The condition specific measures (Aberdeen Varicose Vein Questionnaire score and Oxford Hip and Knee scores) focus on clearly defined aspects of the patient's clinical condition which would be expected to be affected by their procedure. The Aberdeen Varicose Vein score, on a scale between 100 (worse) and 0 (better), is based upon 13 weighted questions specifically related to varicose veins. The Oxford Hip and Knee scores, on a scale between 0 (worse) and 48 (better), comprises twelve multiple choice questions including the patient's experience of pain, ease of joint movement and ease of undertaking normal domestic activities such as walking or climbing stairs
10. PROMS participation rates are rounded to the nearest 100 in this press release.
11. For media enquires please call 0845 257 6990 or contact mediaenquiries@ic.nhs.uk

Tags: