Measuring Patient Outcomes & Experience - Easily

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

2011-10-24T17:41:00.000+01:00

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

2011-10-24T17:37:00.000+01:00

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

2011-08-25T11:13:00.001+01:00

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

2011-06-15T09:02:00.001+01:00

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

2011-06-15T08:58:00.000+01:00

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

2011-06-15T08:50:00.000+01:00

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

2011-03-04T08:57:00.000Z

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.

Podiatry services measure Patient Reported Outcomes (PROMS) using COM-Q service

2010-11-09T13:07:00.000Z

Using PROMS routinely in Podiatry services can be a significant burden or impossible for many.

Two new case studies have been published showing how two NHS Podiatry Services used the COM-Q service provided by CoMetrica to measure the impact of the work they do using PROMS and experience measures. The two services, Solent Healthcare and South Birmingham Community Healthcare recently reviewed results of both clinical outcomes and patient experience. More information can be found on the CoMetrica website including copies of the case studies.

Case studies

Choosing the right model to measure Patient Experience

2010-08-29T14:14:00.000+01:00

Choosing the right model for measuring patient experience can be a daunting task with a number of different options all aiming to achieve "near real time" patient experience measurement.

This article by Stuart Mathieson compares the different measurement models currently available in the market and highlights the shortcomings and advantages many have found with particular routes. With NHS guidance emphasising the need for "near real time" measurement, it is easy to to think that getting patients to answer a few questions on a touch screen device will meet all your needs. However, the very patients who you most need to listen to are the ones least likely to use such devices and you could be left with a small skewed sample of patients answering a few superficial questions.

While using touch screen devices "ticks a box" it does not provide you with what you need in terms of reach, linkage to patient data and detail over the entire patient pathway.

Many Trusts are now ditching superficial systems to invest in comprehensive services which can reach out to ALL patients using multiple routes and most importantly, do not take up valuable front-line staff time. Read the relative merits and shortcomings of each approach before you invest. You can download this document from the CoMetrica website here.

Other articles describing how Patient Experience & Outcomes can be measured are on the website http://www.cometrica.co.uk/

"There's an App for that"

2010-08-18T09:26:00.000+01:00

Recent months have seen the fashion for smartphone applications, predominantly Iphone “Apps” to proliferate into temporary niche markets related to one-off tasks in running one’s life. Examples are applications provided by estate agents to view their current property portfolio. Some examples of these short-term use apps have appeared in healthcare settings to capture patient experience. Patients are handed a device and complete a survey during their time in the unit.

What benefit does this have?, well interest may be high in certain groups of patients, but a very skewed minority. Most patients are elderly and elderly people resist technology. Given the high volume of people using health services each day, it is easy to create an illusion of success by getting say 50 responses per day. A simple analysis of patient age quickly shows that this sample is a skewed fraction of patients and the aim of the survey is unmet.

This applies to other device based capture system – they will always be a minority sample limited by patient familiarity, number of devices, time to complete, staff time to manage and explain and conflicting priorities for staff and patients alike. That is not to say that such approaches are worthless, but their use must be matched to carefully segmented groups where device capture can excel. An example is long term conditions in younger people, such as asthma or diabetes where mobile phone based apps can be highly effective.One of the key success elements of these is that something is known about the person pushing the button.

Avoid superficial box ticking

The more you know about the diagnosis, treatment, services used and demographics of the respondent, the more useful the resuts are. This is the major failing in many experience and outcome capture systems, they are not linked to patient data in any way. Some recent developments attempt to address this by asking the patient for data items you already know such as How old are you? Which services did you use? The problem with this is that you quickly exhaust the patients attention by wasting their time completing categorical information before you get to the meat of the survey.

The ideal is to drive survey content by the systems which already have this data recorded, even the most basic patient administration systems can do this. This has the benefit of generating bespoke surveys at the time, where the content is matched to the individual, so every question is relevant to them. The advantage is that results are no longer superficial.

No Burden

CoMetrica has developed such a service for organisations which is fully managed so all the measurement is carried out by CoMetrica and the healthcare organisation can focus on the results. The difference is, you no longer get a superficial sample, you get detailed responses from most patients. CoMetrica aims to get responses from the majority all patients going through each service. The results are then really powerful, detailed and have the benefit of continuity. For more information, see examples at http://www.cometrica.co.uk/ or contact Stuart Mathieson by email: Stuart.Mathieson@CoMetrica.co.uk

Image based surveys at www.CoMetrica.co.uk

2010-08-06T11:54:00.002+01:00

Health & care organisations can now use pictorial questionnaires to prompt their patients, clients and residents. Using images reaches out to children and people with communication difficulties and the images can be powerful psychometric measures as well as factual clinical or environmental experience prompts.

Conatct us for more informatuion on how we can use our comprehensive service to measure the experience of all your patients, clients or residents continuously.

http://www.cometrica.co.uk/

New Website live at www.CoMetrica.co.uk

2010-08-06T11:49:00.002+01:00

Our new improved website has now gone live where you can see the latest news on measuring Patient & Client Outcomes & Experience

http://www.cometrica.co.uk/

Measuring & using patient's reported experience & outcomes in Health & Care

2009-10-18T17:47:00.000+01:00

Welcome to my blog and please feel free to contribute.

People who use NHS or private healthcare often describe their carers as "kind and helpful". Few consider that improvement in their health or maintenance of their state of health is usually directly reliant on the skill and competence of these staff rather than just "good or bad luck"

The UK government is now empowering patients to assess themselves the effectiveness of their treatment and their experience. Against a tradition of the medical model, this will take some time to be widely accepted. However we are now seeing patients go beyond the "kind & caring" comments to record their actual experience and their own perception of their health state before and after treatment, or during care.

CoMetrica provides a fully managed service to health & care organisations so that the collection of patient experience and outcomes can become an integral part of the service that organisation offers.

Contact me at Stuart.Mathieson@CoMetrica.co.uk if you are a health or care provider interested in this service. If you are a patient, let me know your views by leaving a comment in this blog.