Flashcards in HaDSoc 5.2 patient reported outcomes Deck (26):
Why should we measure health?
-Have an idea of the health needs
-helps with resource allocation
-can look at effectiveness of interventions
-look at quality of health services (Are people happy with the service?)
What are some commonly used measures of health?
-patient reported outcomes
What are some pros and cons of using mortality as a measure of health?
-it is easily defined
-its not always recorded properly (wont know the cause of death)
-not a good measure of outcome (death shouldn't really be an outcome)
What are some pros and cons of using morbidity as a measure of health?
-its already widely collected (general health checks etc)
-collection isnt always accurate
-not easy to evaluate
-no insight into the patients experiences.
why use a patient-based outcome?
To attempt to assess well being from the patients perspective.
- good for conditions where there is no cure, just management.
-good for looking at iatrogenic effects of care (are certain parts of the treatment affecting the patient negatively?)
What does PROMs stand for?
Patient reported outcomes measure.
What are some uses of patient reported outcomes?
-used in audit
-used to evaluate quality of care
-used to look at effectiveness and benefits associated with cost
-used to measure health status of populations
What happens to the data collected by proms?
-comparisons can be made between trusts
-patients can use it to help them make decisions
-of interest to commissioners
What are some drawbacks of PROMs?
-take a lot of time to collect, analyse and publish
-difficult to get everyone to participate (introduces bias)
-need to make sure they arent being misused
Define health related quality of life.
'the functional effects of an illness and its consequent therapy upon a patient, as percieved by that patient.'
How do we measure HRQoL?
-specific or generic instruments
What 2 properties must a quatitative instrument be, in order to be a good PROM?
-validity (does it measure what it should measure?)
-reliability (is it accurate over time and internally consistant, are any changes recorded due to a change in the condition, instead of the way the questions are asked etc)
What are some advantages of using published instruments instead of unpublished, for PROMs?
-they've been proven to be reliable and valid
-you can compare across different groups becuase they are widely used.
What are some advantages of generic instrument use for PROMs?
-you can use them on any population, including healthy people
-good for a broad range of problems
-can detect unexpected effects of interventions
-can assess the health of populations
What are some disadvantages of generic instrument use for PROMs?
-Patients may not feel they're relevant so may not complete them
-May be too broad, overlook things, be too general
-They're less details
-less sensitive to changes that occur after an intervention
What are some examples of generic measures for PROMs?
-Short form 36
What is the SF 36? describe it's properties.
A short questionaire of 36 questions, coverring 8 domains, which looks at health over the past 4 weeks.
Is widely used in research
proven to be reliable and valid.
What are the 8 dimensions of the SF 36?
-role functioning (physical)
-role functioning (emotional)
How does the scoring of the SF 36 work?
Scores relating to a single domain can be grouped together.
Scores across domains cannot. (takes more analysing)
No overall score.
What are some advantages of the SF36?
-acceptible to people
-only takes 5-10 mins to fill out
-high internal consistency
-it's responsive to change
-widely used so theres population data available for comparison.
Discuss features of the EuroQol 5d.
questions 5 dimensions of health, and generates a single index between 0 (death) and full health (1).
Commonly used as a stand alone measure.
What are the dimensions of the EQ 5d?
(each has 3 levels, no problems, some problems, severe problems)
What are the 3 types of specific instruments used for PROM's?
-disease specific (eg asthma QoL questionaire)
-site specific (eg hip, shoulder)
-dimension specific (eg pain, depression)
What are the advantages of specific instrument use for proms?
-very sensitive to change
-more acceptible to people
-very detailed (relevant)
What are some disadvantages of using specific instruments for PROMS?
-may miss unexpected effects (very specific)
-can't be used for people who don't have the disease