What is PROMs?

Quality of care is at the centre of today’s healthcare. Although the NHS is faced with making huge savings in costs, this is not envisaged as being at the expense of the quality of services delivered to patients.

In 2008, the report by Lord Darzi painted the picture of an NHS that has quality of care at its heart, and in 2010 the NHS White Paper, published soon after the coalition government came to power, went further in highlighting the importance of health outcomes. This reflected a fundamental shift by the government as to how healthcare was to be evaluated, moving from the process targets endorsed by the previous Labour government, such as waiting times, staffing and bed availability, to improvement in outcomes, particularly the health of patients.

Outcomes Framework 2011/12

Identified effectiveness, safety of treatment and patient experience as key measures by which healthcare would be evaluated. This was followed by the Commissioning Outcomes Framework published at the end of 2011 outlining the means of doing so and included patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) as key indicators.

PROMs are questionnaires that measure health as viewed by the patient. They have overtaken the so-called surrogate outcomes such as biological markers, reported on by clinicians.
The NHS adopted the routine use of PROMs to evaluate four elective surgical procedures: hip and knee replacements, varicose veins and hernia repair. Patients were asked to report on their health status before the operation and three to six months later.
Up to June 2011 the NHS had amassed a database of nearly 250,000 records detailing PROMS after these interventions. The move now is to expand PROMs into more complex interventions and difficult to treat long term conditions that account for significant NHS expenditure, such as diabetes, asthma and stroke.

For many years because of a lack of biological outcomes in musculoskeletal conditions such as back and neck pain, the chiropractic profession, primarily through its research effort, has built up considerable expertise in PROMs. In clinical trials and observational studies, we have been using PROMs for years to evaluate treatments and identify subgroups of patients who get better.

This is an obvious opportunity to capitalise on, not only by collecting PROMs routinely in chiropractic practice, but by doing so well and with some authority.To make good use of this opportunity the BCA has agreed to part-fund the implementation of a PROMs collection unit at the AECC. This will not only collect PROMs but look at innovative ways of disseminating the information to all stakeholders including clinicians, patients, GPs and commissioners.

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