NJR Patient Reported Outcome Measures
Currently, all NHS patients who are having hip or knee replacements, varicose vein surgery or groin hernia surgery are being invited to fill in Patient Reported Outcome Measures (PROMs) questionnaires as part of the Department of Health’s PROMs programme. The NHS asks patients about their health and quality of life before they have an operation, and about their health and the effectiveness of the operation afterwards at six months. This programme is part of the NHS measuring and improving the quality of its care.
Combining these ‘patient outcomes’ with the ‘clinical outcomes’ data from the NJR will give a more comprehensive picture of the outcome of operations.
Extending national PROMs
The NJR has undertaken a project that will extend the PROMs follow-up in order to help surgeons better understand the influences behind the success of joint replacement in the long term.
The aim of the NJR’s extension of PROMs is to provide data that will allow surgeons to understand what influences the success rate of operations from a patient’s perspective. It is hoped this will feed into continued improvements in the treatment of patients.
Professor Alex MacGregor, NJR Research Sub-committee member who is closely involved with the project adds: "This extended data will provide the largest and most comprehensive assessment of the long-term consequences of hip and knee joint replacements and their determinants in England and Wales."
The NJR Steering Committee agreed in 2009 to undertake PROMs at one, three and five years. Year 1 was completed in 2010; Year 3 data collection in 2013 [analysis of year 3 work currently underway] and now plans are being made for the implementation of Year 5 from 2015.
Data from the five-year extended NJR PROMs cohort has been collected up to Year 3 for a cohort of 50,000 patients with hip and knee replacements (25k hip; 25k knee), with linked questionnaire data available at baseline, 6 months, one year and three years. The baseline questionnaires relate to a consecutive sample of national PROMs questionnaires received in 2010. The intended follow-up is for 2015.
Analysis of the linked data started in the summer and results will be included in an interim report shortly. The team’s focus in the initial analyses was of understanding the optimal timing of PROMs response after surgery, the predictors of response, and variation in trajectories of response.
The longitudinal analysis will be augmented by the inclusion of national PROMs data at 0 and six months from an additional 300,000 patients. The work is being carried out at Bristol (Blom) and UEA (MacGregor). Analytical approaches will include the use of growth models that will be implemented by Adrian Sayer
, honorary NJR fellow in Bristol. The statistical team includes Michele Smith (Bristol) and Helen Doll (UEA).
The longer-term goal is to look at PROMs as a predictor for failure. This will only be optimally achieved once the study includes five-year follow up data in 2015.