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

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.

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.