Gloucestershire Care Services have implemented the COM-Q service to measure the impact of treatment in their MSKCAT Services.

Gloucestershire Care Services have implemented the COM-Q service to measure the impact of treatment in their MSKCAT Services.

These services are specialist therapy services available locally to patients who have a range of Muskulo Skeletal problems. The service needed to measure the efficacy of their treatments using standardised patient reported measures and so chose the COM-Q service for its flexibility and ease of use in implementing PROMS.

The service is using a wide range of standard PROMS mesasured at referral stage and after 3 months to measure progress. Patient experience & satisfaction are also collected seamlessly in a single patient friendly questionnaire which has personalised content enhancing response rates.

The measurement service went live on the 18th October and within days the department was reviewing initial results through the on-line reporting portal without any of the hassle of doing the measuring themselves.

For more information about the project contact Iain Cockley-Adams at Gloucestershire Care Services or Stuart Mathieson at CoMetrica

University Hospital of North Staffordshire uses COM-Q to measure experience of all A&E service users

The University Hospital of North Staffordshire in Stoke on Trent is undergoing major change with the phased relocation to a brand new hospital.

The Trust is to move its A&E services from the old Royal Infirmary soon and wanted to measure the experience of A&E service users before and after the move to ensure that demonstrable improvement in the A&E experience was felt by their patients.

The service chose the COM-Q service for its flexibility to ask different questions of different patients and link the results to patient data, producing quantitative reproducible measures for comparison over time.

It was important that all A&E users were included in the measurement, including the parents & carers of patients where required rather than a samll skewed sample which often results when using passive capture in the clinical setting.

The measurement will include all 500 patients per day going through the A&E department for treatment and those admitted for tests or observation in one of the admission wards over a one week period. This will be repeated over the coming months before and after the move to the new hospital site.

For more information about the project contact Helen Inwood, Deputy Director of Nursing at University Hospital North Staffordshire or Stuart Mathieson at CoMetrica.

New PROMS data shows no overall health improvement for many patients after surgery

The Department of Health has recently published the results of the national PROMS programme for the period April 2010 to March 2011.

This shows that although condition specific PROMS (e.g. Oxford Hip & Knee scores) show an improvement in nearly all cases, the overal health of the patient has not improved for many.

The chart shows that scores improved in the condition specific PROMS for Hips, Knees and Varicose Veins but there was a slightly lower level of improvement in the general health status EQ5D PROM. This is not surprising given that patients who have these operations tend to be older and may have other conditions impacting on their health, but does confirm that these operations are less "life changing" than patients might have hoped for. The results also show the disconnection between the Visual Analogue scale question score results and the calculated composite score for the other 5 questions in the EQ5D.

In many cases, the VAS adds confusion and we often recommend leaving this out of continuous measurement. For more information about how to implement and use the results of these and other PROMS, contact Stuart Mathieson at CoMetrica.

Audiology services develop improved pathways

Audiology services use Patient Experience to develop improved pathways

As part of the NHS Improvement organisation’s brief, Audiology pathways have come under review with the publication of a Shaping the Future of Audiology publication. The recommendations follow the usual review of any unnecessary steps and delays to improve throughput but also recognises the importance of continuously listening to patients. Services which involve pathways which can cross professional boundaries can particularly benefit from structured stage measurement of patient reported experience and outcome.


Measures can include not just satisfaction but also PROMS such as the Outcome Inventory for Hearing Aids (IOI-HA). One of the problems with traditional experience and outcome measures is that when they are administered by staff, apart from the potential confidentiality and influence issues, measurement is fixed around visits. This leads to artificial and inaccurate results because the longer term impact is not measured. The best way of avoiding this is to use timed stage measurement so that patients, their carers and relatives can have their ultimate clinical outcomes and pathway experience followed up automatically after a given time period even if the patients have been referred on or been discharged.

Measurement is not just about questionnaires, departments involved in re-design have seen the value of patient focus groups, more extensive commentaries and patient stories.


Managing such programmes can be time consuming and therefore expensive but services such as the COM-Q service from CoMetrica can help achieve this easily.

This service has the added value of being tied into patient data and being able to generate patient specific measurement content which can use images and graphics so opens up measurement to children, those with learning disabilities and other communication impairment.

This article comes from the June edition of Outcomes published by Cometrica. The newsletter can be downloaded here

Transparency in Care quality

Is CQC annual assessment adequate to provide local assurance?

The recent Panorama documentary highlighted the appalling treatment of residents at Winterbourne View unit in Bristol and drew sharp criticism of the CQC’s failure to investigate. How reliant should we be on national bodies to ensure high standards are met in the delivery of care?

There is clearly a national role for regulation, registration and the setting of standards, but should we be reliant on annual inspections to provide assurance? There seem to three ways of monitoring of care quality currently: Self assessment by the organisations themselves based on local managers form filling, Annual inspections on an ad-hoc basis or in response to recognised concerns and whistleblowing which led to the panorama undercover investigation.


For care provider organisations, having continuous impartial assurance from residents and their families is a fundamental requirement often overlooked or only given cursory “annual resident survey” status. There is a need for continuous anonymous feedback from residents, relatives and staff to be an integral part of care provision. For information on how this can be achieved, contact Stuart Mathieson at CoMetrica on 07973 212306

This article comes from the June edition of Outcomes published by Cometrica. The newsletter can be downloaded here

NHS Future: Patient Involvement gets serious

NHS Future Forum reports


The Department of Health has published the report of the stocktake exercise on the governments plans for the future of the NHS.


While many spectators have focused on the recent apparent U-turns in policy ( such as slower speed of the establishment of commissioning boards, wider non-GP representation, the reduced role of Monitor as promoter of competition etc), the role of patients to be genuinely involved in decision making has been strengthened in the forum’s recommendations.

“ ‘no decision about me, without me’ must be hard‐wired into every part of the system “

The report recommends that shared decision making becomes a reality, replacing any tokenism or paternalism in patient involvement. Such decision making would be informed by transparent, public local commissioning plans based on evidence.

Better information about outcomes should be measured and made available and commissioners should require improved collection and use of outcomes & experience data at a local level.

“Clinicians said they wanted to have better access to accurate data about health outcomes so that they could benchmark outcomes and improve services”

Measuring and comparing outcomes should be a standard part of service provision, challenging provision based on custom & practice. This means that for all services provided, the clinical impact and experience, as perceived by patients and carers themselves,, should be measured and taken account of commissioning decisions.

Carers, Parents, Family involvement

In considering the effectiveness of care, the measurement of outcomes & experience needs to embrace a “whole systems” approach which can cross boundaries and takes account of the views of those who are caring for patients in their own environment.


This means that measuring experience cannot be achieved by a few patients being asked to “push a satisfaction button” on a screen while in clinic or hospital, but a structured system which allows relevant and focused questions to be answered by patients and their carers in an unpressured environment. Of particular importance are the patient stories and commentaries which are often so revealing in highlighting good and bad practice.


Other recent government announcements of significance in healthcare include David Cameron’s five promises “a continued real increase in NHS funding, retention of the 18 week maximum wait, not breaking up care, maintaining universal coverage and not ‘selling off’ the NHS”

This article comes from the June edition of Outcomes published by Cometrica. The newsletter can be downloaded here

The Future Forum report can be downloaded here

Ambulance Trusts look to quality as response targets are revised

The response time target for Category B calls is to be scrapped but the government is leaving the target for achieving 75% of life threatening calls responded to within 8 minutes.

New indicators will be used to look at the patient pathway and the contribution of the emergency services to patient outcomes. This has prompted many ambulance trusts to look beyond the annual patient satisfaction surveys they may have done to making the measurement of patients experience and outcomes an integral part of service delivery. Using as system such as the COM-Q service from CoMetrica allows patient experience and outcomes measures to be connected to patient data and allow the longer-term outcome of patients to be measured. This has been an unknown for emergency services who rarely find out the ultimate outcome of patients they deliver to A&E.

The move towards clinical pathway based indicators for time-sensitive diagnosis and treatment such as stroke and cardiac re-vascularisation has been welcomed by doctors.