Getting the most out of PROMs: Putting health outcomes at the heart of NHS decision-making

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More than 100 years ago Florence Nightingale suggested a health-related outcome measure for her patients: relieved, unrelieved and dead. Despite the developments in medical technology since then, attempts to measure the positive outcomes of health care have been slow in coming.

An important step forward was made in 2009 when the English NHS began collecting patient-reported outcome measures (PROMs) for four elective procedures. Using a series of structured questions that ask patients about their health from their point of view, PROMs are intended to enable the patient perspective to inform decision-making at all levels of the NHS.

Evaluating the outputs of health care services is not straightforward as services must be looked at in terms of their effects and not simply 'added up' to measure what is produced.

Traditional clinical ways of measuring health and the effects of treatment are increasingly accompanied by PROMs. Although it is argued PROMs should supplement, rather than replace, existing measures of quality and performance, they are likely to become a key part of the way health care is funded, provided and managed.

The aim of this report is to provoke and encourage thinking about the wide range of ways in which PROMs data can be used to inform decisions. It draws on Bupa's example to discuss how providers can use PROMs data to improve clinical performance. It also offers practical advice for commissioners in using PROMs data to assess value for money and decide how to purchase health care systems.

As nearly one-fifth of UK government spending is on health and with financial challenges facing the NHS, it is important to be able to answer questions about the value and outcome of services. The report concludes by showing how measuring outcomes from the patient perspective has the potential to lead to important improvements in service delivery and patient health.

While PROMs have the potential to transform health care, the way the data are analysed and the costs of collecting, processing and reporting must be considered alongside the benefits of this new information.

Ultimately, whether the NHS gets the most out of PROMs depends on the willingness of decision-makers to make tough decisions about services that are ineffective and to promote practices that benefit patients the most.


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