The use of Patient Reported Outcome Measures (PROMs) in mental health

Abstract

If successful, the placement will consist of two proposed distinct programmes.

1. Research Programme
Patient Reported Outcomes Measures (PROMs) are short questionnaires completed by the patients about how they perceive their health-related quality of life (HRQoL). The Department of Health (DH) has been collecting PROMs data routinely for patients who have undergone knee replacement, hip replacement, and varicose vein and groin hernia (DH, 2009). The health status information collected from patients by way of PROMs questionnaires before and after treatment provides an indication of the outcomes or quality of care delivered by the NHS. DH intends to roll out the collection of PROMs to other conditions, including mental health in secondary care where there is little evidence (DH, 2010). The research prgramme can be divided into three different parts.

Part 1: Analyse the psychometric properties of the PROMs data obtained from patients with depression.
Part 2: Use benchmarking techniques to ensure that PROMs data collected is useful for users and clinicians (Barkham, 2001). Benchmarking refers to the method of comparing the performance of routinely delivered service using the PROMs date with a view to allow comparisons.
Part 3: Carry out exploratory work with clinicians, users and managers to develop ways of presenting PROMs data. Routine use of PROMs data by clinicians and service users has received limited attention within academia and in practice.

2. Capacity-building programme. The fellow proposes to provide a series of monthly workshops for 6 months. The exact content of these workshops will be discussed with the host at an early stage to ensure that they are of utmost relevance to Sheffield Health and Social Care Trust (SHSC) staff. The capacity-building work, in the form of seminars will include introductions to: health economics, outcomes measures, health economic modelling and to economic evaluation.

The primary base of the fellow will be SHSC Trust but the benchmarking work and data analysis may require collaboration with Rotherham, Doncaster and South Humber (RDASH Trust). From a CLAHRC perspective, this project links with the existing Depression theme and the forthcoming PROMs theme.

The applicant hopes that the work carried out during the placement will lead to publication and conference papers which will be of benefit to academic audiences more broadly. Through wider sharing of the work, there will hopefully also be an opportunity to develop bids in this area, possibly to extend to mental health conditions other than depression.

Planned Impact

The research will be an important contribution in academia at regional, national and international levels . By its multi-disciplinary nature, it will be of interest to health economists, medical statisticians, researchers in mental health and clinical psychologists.

It is expected that the general public accessing care will benefit from this research. One contribution of the research is to identify the best ways of presenting the data collected from PROMs to them. Ideally when receiving care, patients will have access to their own data and will be able to benchmark their 'progress' compared with others with similar health issues and undergoing similar treatments. First, by having access to their progress through PROMs data, patients may engage better with their treatments and can lead to closer interest in monitoring of their health which may, in turn, result to better outcomes. Outcomes from treatment will be compared between primary and secondary care wherever comparable. Second, this data may provide patients with information so that they have greater choice of where to be treated and potentially what treatments to opt for. Third, if the collection of PROMs is rolled out to all trusts, at a broader level, patients will be able to will to compare their outcomes with others throughout the country. Having an exact picture of one's care is necessary in improving health and well-being.

Clinicians and healthcare managers will have access to PROMs data related to the care delivered, in a format that makes sense to them, which can help them in their clinical and managerial decisions respectively. For clinicians, this can be an important tool in shared decision-making where both clinicians and patients can use the data to provide the basis for discussing the progress and identifying potential treatments. Commissioners may also use the data from outcomes of their service users of their trust (and others when available) to assist them in making decisions in the context of world-class commissioning. It is expected that this research will encourage the Trust, as an organisation to make the most of its existing information infrastructure.

Trust staff will benefit directly through knowledge transfer and shared learning. The placement will help enhance the analytical skills of SHSC staff who will be able to carry on performing and using these analyses in the Trust after the placement concludes. The Trust will be in a position to build on the research to apply it to its day-to-day activities. SHSC is looking to enhance its research capacity and increase collaboration with ScHARR.

The Department of Health is also going to benefit from this research in the context of their national PROMs programme. While there has been significant development in the interpretation of PROMs data to compare providers, little work has been done on how data PROMs can be used in clinical decision-making. The research of benchmarking in mental health can be adapted and tested in other areas.

Publications

10 25 50
publication icon
Jennifer Roberts (Co-Author) (2014) Quality of life impact of mental health conditions in England: results from the adult psychiatric morbidity surveys in Health and Quality of Life Outcomes

 
Description The research funded on this grant highlighted the weaknesses associated with patient reported outcome measures that are currently being used in mental health services. The research made it clear that a new generic measure that is acceptable to all patients and types of clinicians is needed. Consequently a new measure called Recovering Quality of Life has been developed.
Exploitation Route The Recovering Quality of Life PROM was launched in Westminster in October 2016. NHS-England did not explicitly recommend a measure for use in the NHS to measure the outcomes of mental health service users and instead left this decision to individual trusts. Over 100 licences have been granted to NHS trusts and academics overseas and nationally. Once the preference weights for the measure are available, we can expect ReQoL to be more widely used in studies and trials. The ReQoL measures have been translated into 4 Indian languages and into German.
Sectors Healthcare,Pharmaceuticals and Medical Biotechnology

URL http://www.reqol.org.uk
 
Description This research highlights the importance of collecting patient reported outcome measures in general but specifically in mental health. It has led to discussions with the importance of doing so at the level of the local trust involved in this research as well as the national level. This research also triggered two important pieces of research - one on development of a new generic outcome measure called Recovering Quality of Life (ReQoL) and another piece of research on the best ways of collecting PROMs. ReQoL was officially launched in October 2016 and is available for use.
Sector Healthcare
Impact Types Policy & public services

 
Description Recovering Quality of Life - Development of a new generic PROM in mental health 
Organisation Department of Health (DH)
Country United Kingdom 
Sector Public 
PI Contribution The need for a new generic measure in mental health became clearer during the work undertaken as part of the ESRC fellowship. As a result, a proposal to develop such a measure was submitted to the Department of Health as part of the work programme for the Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU) at the University of Sheffield. The proposal had been accepted and the measure is now in development and will be ready for use by the summer of 2015.
Collaborator Contribution The Department of Health has put us in touch with the relevant sections within the Department of Health that have an interest in such a measure. As a result, we have the expertise and the development of this measure benefits from the inputs of a number of stakeholders at each stage.
Impact The final output in the form of a new measure will be available in the summer of 2015.
Start Year 2014