New outcome measures are to be introduced in four types of surgery

New standardised measures of clinical outcomes in the NHS, to be based on detailed information from patients themselves, are to be introduced across England from April.

The data, which have been hailed as marking a breakthrough in measuring the quality—as opposed to the quantity—of NHS treatment, could be used to assess clinicians’ and hospitals’ performance as well as to evaluate the success of different treatments.

Called patient reported outcome measures (PROMs), they will initially be introduced in four common forms of surgery—inguinal hernia repair, varicose vein surgery, and knee and hip replacements—where the measures have already been extensively trialled by the Royal College of Surgeons and the London School of Hygiene and Tropical Medicine. Around 250 000 patients are expected to be involved in the first year.

The system asks patients questions about their quality of life before the operation and then again six months afterwards. Areas covered by the questions include mobility, pain, mental health, and overall health. Comparative data are then used to calculate a numerical value for the improvement to their health.

Every provider, including independent organisations offering NHS treatment, will be asked to invite patients to fill in questionnaires before their operation. An outside contractor will then be responsible for collecting and analysing the data from postoperative questionnaires.

It is expected that the first sets of outcome measures, those for hernia and varicose veins, will be available by the end of this year, while those for orthopaedics will be available by April 2010. The information will also be published on the NHS Choices website (www.nhs.uk).

Although PROMs are currently restricted to four surgical procedures, the Department of Health said that research was already under way to identify other areas where they may be feasible.

The new approach was welcomed by the Royal College of Surgeons. The college’s president, John Black, said, “Surgeons can tell you how they think the operation has gone, but what they need to know is how the patient feels about the whole outcome.” It was important that the information was integrated with other outcome measures and that clinicians were involved, he added.

PROMs went way beyond simply measuring patients’ satisfaction and had the potential to transform health care, said John Appleby, chief economist of the health care think tank the King’s Fund. He suggested that primary care trusts could use them to identify the best performing hospitals and clinicians. They might also inform the revalidation of clinicians and the performance management of hospitals, as well as helping to re-evaluate old and new treatments.

Nigel Edwards, policy director at the NHS confederation, said, “PROMs are part of the next big shift for the NHS as it moves from simply taking people in, performing operations, and counting the numbers to measuring the extra value that treatment has made to a patient’s quality of life.”

But he said that implementing PROMs would require an “industrial scale increase” in the amount of patient feedback and information collected by the NHS. And, he warned, it had to be done in a way that didn’t impose unnecessary bureaucratic burdens on the NHS.