Use of PROMS in guiding commissioning and clinical decision making

Commissioning in the NHS will increasingly focus on outcomes of providers. There is limited experience on which to build. The emphasis on quality of life as an outcome for long-term conditions is particularly challenging, given limited available data. An exception is the data on outcomes for four elective surgical procedures which have been monitored via PROMs on a national basis since April 2009.

PROMs data also have the potential to impact on clinical decision-making (rather than commissioning choices). QORU will collaborate with other research centres. We aim to collaborate with other colleagues on a study linking PROMs and referral decisions.

Aims and Methods

Strand 1: Using PROMs to guide commissioning

A collaborative project has been set up with Professor Barry McCormick and colleagues in the Centre for Health Service Economics and Organisation (CHSEO), Oxford, to examine the use made by commissioners of outcomes data for the four elective surgical procedures covered in the national PROMs programme. Results will be directly relevant to commissioning for the wider range of long-term conditions.

The specific aim is to assess whether and how commissioners and patients can best use PROMs information to guide their decisions about services and support options for people with LTCs, specifically by generating comparative data on costs and health outcomes for elective surgical procedures, particularly drawing on PROMs.

Data on costs and health outcomes via PROMs will be calculated and related to populations served by Clinical Commissioning Groups (CCGs). Evidence will be fed back to CCGs and their interpretation and use of the data by CCGs will be examined.

Strand 2: Using outcomes data to establish thresholds or criteria for referral

Evidence is now available to allow examination of the outcomes of elective surgery for two orthopaedic procedures (hip and knee surgery) covered by the national PROMs programme. At the same time, there is growing debate about whether PROMs can be used to establish thresholds for referring patients for assessment for possible surgery. We will work with colleagues in Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford and University of Bristol, to examine the use of PROMs for selected conditions as sources of evidence for thresholds for referral and resources to support decisions by patients, GPs and others involved.

Timing and Outputs

Strand 1 is a three-year project which commenced in Autumn 2012, with peer-reviewed publications intended.

The clinical decision-making strand of the work is partly dependent on separate funding. We anticipate needing a short development phase for this work. Outputs can then be expected towards the end of Phase II.