PROMs and PREMs in government programs Catherine Katz Director, - - PowerPoint PPT Presentation

PROMs and PREMs in government programs

Catherine Katz – Director, Safety and Quality Improvement Systems and Intergovernmental Relations

➢The Commission’s background ➢Patient reported measures ➢PREMs and PROMs and the Commission’s role in patient reported measurement ➢Governments’ interest ➢The PaRIS project

This presentation covers:

2

About the Commission

The Commission’s role is to lead and coordinate national improvements in the safety and quality of health care. The Commission works in four priority areas: 1. Patient safety 2. Partnering with patients, consumers and communities 3. Quality, cost and value 4. Supporting health professionals to provide care that is informed, supported and organised to deliver safe and high-quality health care.

3

Evaluation of safety and quality of care

A robust safety and quality monitoring system requires triangulation of multiple measurements from multiple perspectives

• Clinical and

administrative data

• Patient

perspective (PROMs and PREMs)

Holistic picture

• f safety and

quality performance Atlas of Variation Clinical Trials Hospital Acquired Complications Clinical care standard indicators Audits/ point prevalence studies Core Hospital- Based Outcome Indicators Sentinel Events NSQHS Standards Patient experience and PROMs Staff experience Incident surveillance Clinical Quality Registries 4

• Patient reported measures (PRMs) provide insight into the effect that

health interventions have from the perspective of the service user/patient.

• They evaluate either outcome (patient reported outcome measures -

PROMs) or experience (patient reported experience measures – PREMs)

• There are other patient reported measures such as patient reported

incident measures (PRIMs) which are safety indicators of perceived harm.

Patient Reported Measures

5

PREMs vs PROMs

Patient-reported experience measures (PREMs) Patient reported outcome measures (PROMs) Patient’s assessment of: (a) whether or not, and how often, they

• bserved certain events during an

episode of care or consultation, and (b) the quality of their encounters with staff, healthcare environments, care delivery processes such as pain management, and administrative processes during that episode of care or consultation Patient’s assessment of the impact of a period of care or a particular intervention, in terms of factors such as level of pain, symptoms, mobility, ability to carry out daily activities and fulfil usual roles and psychosocial wellbeing. Usually measures are completed by the same patient at multiple time points to assess change in health status over time

• r pre- and post- intervention

6

Patient experience measurement in Australia: measurement activity by jurisdiction

South Australia

State-wide PEx survey (CATI; CAPI in development) for

• vernight hospital inpatients;

developing CAPI survey for disadvantaged populations

Tasmania (0.52 million)

Some hospitals and services measure PEx independently. Population density map (2012) source: AIHW analysis of ABS ASGS data 2010, 2013

Western Australia

Pioneer of Australian PEx – established survey 15 years

• ago. Annual state-wide survey

(CATI) for hospital inpatients and ED patients

Tasmania

No state-wide survey Some hospitals and services measure PEx independently

Northern Territory

No territory-wide survey Some hospitals and services measure PEx independently.

New South Wales

Rolling state-wide PEx surveys (PAPI and online) for overnight hospital inpatients, ED, children, Outpatients, Cancer Outpatients, Maternity, Small and Rural Hospitals

Queensland

Periodic state-wide PEx surveys (CATI) for Emergency Department (ED), Small Hospitals, Maternity, Outpatient clinics

Australian Capital Territory

Canberra Hospital patient survey

Victoria

Rolling online survey one month post- discharge for ED patients, hospital inpatients, maternity, children and parents

Australia (population = 23.71 million)

Currently no national-level assessment of recent patients’ experiences that can be used for quality improvement

• Australian Bureau of Statistics conducts a population-based survey of experiences, part of a larger health survey, not useful for health services to

identify areas for improvement

• Private hospital groups and insurance funds use their own measurement tools (principally HCAHPS)

7

Australian Hospital Patient Experience Question Set (AHPEQS)

• Aim - development of national tool at the request of the

Commonwealth and state and territory governments

• 12 question core set of patient experience questions

developed by the Commission as nationally consistent PREM tool

• Based on conceptual framework developed with 16

patient focus groups and refined with clinicians, managers and policymakers

• Non-proprietary, for use in private and public sectors
• Final set finished in 2017 – now in a trial phase

8

Building momentum

• 160+ hospitals and health services already collecting AHPEQS

nationally (c. 80,000 completed surveys since Jan 2018 – as of Aug 2018)

• Public and private sector uptake
• All public hospitals in Tasmania and SA
• WA and Victoria – active interest for state-wide use
• DVA trialling prior to national rollout

9

Next step is national specification

Visit https://ahpeqs.safetyandquality.gov.au

10

• ‘A PRO is directly reported by the patient without

interpretation of the patient’s response by a clinician or anyone else and pertains to the patient’s health, quality of life, or functional status associated with health care or treatment’.*

• Measurement tools are generic (health related quality of

life) or specific (function or symptoms such as pain related to a specific disease) – there are many around

• Measurement requires pre- and post- intervention to

compare outcomes

• Aim: to shift from clinical specific outcomes to health
• utcomes that matter to the patient

Patient-Reported Outcome Measures

11 * Weldring, T & Smith SMS. Patient-reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs) Health Serv Insights 2013 6: 61-68

• health status assessments
• health-related quality of

life (HRQoL)

• symptom reporting measures
• satisfaction with care
• treatment satisfaction measures
• economic impact measures
• specific dimensions of patient

experience such as depression and anxiety.

Various assessments and measures

12

PROMs can lead to improved healthcare safety and quality

• Logical chain of activities at various stages: data collection,

aggregation and use

• Activities (mechanisms) are undertaken by stakeholders

at three levels: micro, meso, macro

• Outcomes also occur at these three levels
• All elements in the model interact (feedback effects)

Stage Macro level Meso level Micro level Context for data collection: intrinsic motivation, external sanctions or incentives, resources, systems, organisational culture Data collection Funders provide resources for implementation, external incentives and/or sanctions Policy makers provide leadership, promote research and knowledge sharing, establish standards for collection Researchers and implementation experts guide PROMs collection, analysis and interpretation Healthcare

• rganisations

support and promote PROMs collection Clinicians encourage patients to complete PROMs

• r assist them

during consultations Patients complete PROMs Context for data use: as above, plus data quality, completeness, accessibility, relevance, timeliness, presentation, interpretability, integration with other data Data use Funders use aggregated PROMs for purchasing decisions Policy makers use aggregated PROMs for performance measurement, population surveillance Researchers use PROMs data for comparative effectiveness research,

• utcomes

measurement, exploring links between care processes and

• utcomes

Healthcare

• rganisations use
• wn and others’

aggregated PROMs data to improve processes of care Patients, clinicians, multi- disciplinary teams use individual and aggregated PROMs to inform care during and after consultations Patients use own PROM data for self-management and/or to initiate discussion with clinicians; patients compare own PROM data to aggregated PROMs Context for outcomes: as above, plus data credibility, opportunities and appetite for knowledge sharing, competing priorities, perverse incentives Outcomes Effective resource allocation, value- based healthcare Evidence-based policy and program design, standards, public reporting Evidence-based treatments, clinical guidelines and models of care; benchmarks against standards Quality improvement, sharing of best practice among clinicians and/or healthcare

• rganisations

Shared decision making, person- centred care Improved self- management, informed choice of treatment or healthcare provider

Example:

Quantifying impact of an intervention on patient-reported mobility - CQRs

15

Äldre pall

Source: Evalill Nilsson The National Board of Health and Welfare, Sweden

17

New Australian Health Performance Framework

Source: COAG documents https://www.coaghealthcouncil.gov.au/Portals/0/OOS318_Attachment%201.pdf

18

AHPF opportunities

• Key step towards focussing the system on value based

care

• Integrate patient perspectives on safety and quality
• Improved utility for the public
• More patient-centred reporting
• Greater transparency and accountability
• Builds on the investment in clinical quality registries

(CQRs) to develop of a national policy on CQRs

1. Environment scan – purposive search of organizational websites in Australia 2. Literature review – targeted search of international academic and grey literature – 393 sources 3. Interviews – with 27 international and Australian experts and jurisdictional representatives

What is the Commission doing? A national approach to PROMs.

19

• Environment scan showed that a lot of work is going on in

Australia, but it is scattered, and some level of national consistency and co-ordination may be useful.

• Literature review showed that PROMs can be useful at

multiple levels:

• To inform shared decision making and empower consumers to

self-manage

• To inform professional peer benchmarking and improvement
• To inform organisational quality improvement efforts
• To inform calculations of comparative value of interventions for

resource allocation

• To identify unwarranted variation
• To monitor service performance on outcomes that are important

to consumers

A national approach to PROMs – completed work

20

• Developing advice on the routine use and collection of PROMs

⎻ incorporating learning, information support, coordination and support for national and international collaboration, and implementation support ⎻ advice on a PROM for use in the AHPF

• Four key areas have been prioritised for consideration:

⎻ Engagement of providers and patients to use PROMs in clinical settings to improve patient outcomes ⎻ Developing the capacity to aggregate and translate data into a national perspective ⎻ Provision of advice on infrastructure that provides flexibility for survey design and regardless of the sophistication of medical record keeping. ⎻ Focus on cost effectiveness and feasibility.

A national approach to PROMs- next steps

21

• Objective: develop international, person-centred

benchmarks of health system performance for patients with complex needs, through a survey of PROMs in people 65 and over with chronic conditions, mainly cared for in primary care

• Australia is one of 24 “interested countries” taking part in

the initial build up.

OECD’s Patient Reported Indicator Survey (PaRIS)

22

• Three phases:

⎻ (Initial) Mid 2019-2020 – development of the instrument, survey questions and small pilots with patient to develop the survey questionnaires. ⎻ Mid 2020-mid 2021 – field trial in participating countries. ⎻ 2021 -2023 – implementation of the survey in all participating countries with analysis and dissemination of survey results.

• Potential for Australia – if it participates

⎻ Engagement of patients and providers; embedding of PROMs into clinical practice ⎻ Purpose built for local implementation and use with ability to translate into national view ⎻ Primary care and chronic care focus : validated, consistent PROM for potential Australia-wide use

23

PaRIS

Questions?

24