PROMs promote health gain and patient involvement

Hawkes seems to have swallowed the paternalistic line that what doctors do to patients is more important than the outcome as perceived by them.¹ How can we know if a process brings benefits and continues to improve it without measuring the outcome, and how can we rely on process alone when the evidence shows such widespread variation and inconsistency in process in clinical practice? For patients, there is much more to success than alive or dead. How often have we heard: “They said my hip replacement went well, but I am now housebound” or “He says I have a good flow rate in my bypass graft, but I still get pain at 10 metres”?

Patient reported outcome measures (PROMs), unlike most of the other clinical measures used traditionally (readmissions, infection rates, adverse incidents, etc), usually measure health gain—what actually happens to most patients who interface with the healthcare system. BUPA Hospitals (now Spire Healthcare) have been using PROMs for years, and the high response rates now achieved show just how much value patients put on being asked about their outcome.

Our work (using Outcome Technologies) and that of others is described in Browne et al’s recent paper.² Routine measurement of patient reported outcome is quite easy to do and cost efficient. We are convinced that it can encourage continuous quality improvement and that the data when made available (properly risk adjusted) can help general practitioners and their patients make more informed choices about providers. We were delighted to see PROMs promoted in the NHS operating framework³ and also supported by the Royal College of Surgeons of England. We believe they will reduce the noise in the system, make it more transparent, and help give patients the real say in their health care that they deserve.