1 Patient Outcomes & Experience Measurement in Podiatry Results from two NHS departments.

1

Patient Outcomes & Experience Measurement in Podiatry

Results from two NHS departments

2CoMetrica © 2010

Clinician“I see your ulcer is

healing nicely”

Commissioner“prove these

treatments actually do any good”

Outcomes are easy to see - aren’t they?

Patient thinks“maybe but I still

can’t get to the shops”

Carer/relative thinks“is this the best

treatment available?”

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of everyone not a skewed sample

accurately the right measures at the right time

quantitatively recognised , benchmarked

qualitatively fast direct feedback to the department

continuously not an annual survey – “ticking the

box”

So how can you measure Outcomes & Experience?

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Choose your census points along the patient pathway

Referral 1st visit After visitAfter

treatment

Short-term follow-up 6-12 weeks

Long-term follow-up 6

months+

Key:Clinical Outcomes

Patient Experience

•Generic PROM•Specific PROM •Pre - Tx

•Communication•Organisation•information

•Generic PROM•Specific PROM

•Accessibility•Cleanliness•Facilities•1st impressions

•Pain•Pain management

•Privacy &Dignity•Competency•Information

•Generic PROM•Specific PROM •Post - Tx

•Generic PROM•Specific PROM •Long Term f/up

•Communication

You don’t have to see the patient again to follow them up longer term

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standard PROMS and local measures

clinical AND experience multiple question types:

multiple choice image drawing free text return image recognition Visual Analogue Scales

different questions for each patient group & pathway stage

Example measures available

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clinical images e.g. What do your feet look most like? comparative data follow-up use any images

Image based questions

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Pilot scope 500 patients in summer

2010 Measures:

generic health foot health patient experience

+ continuous daily feedback from patients

Responses 276 returned, 54% response

rate 3% on-line 97% on paper

50% of responses back within 1 week of dispatch

results updated daily volumes provided

statistically significant results

South Birmingham Podiatry ServiceMandy Cadge – Podiatry Services Manager

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Overall resultsScale At treatment

startAfter 60 days

Discharged

Responses n 127 (51%) 121 (50%) 23 (50%)

Average resultsGeneric health PROM – EQ5D

0= feel like “death”1= perfect health

0.55 0.63 0.56

Foot health PROM - FHS

0= maximum pain, mobility restriction1=no pain, concern, restriction

0.52 0.57 0.59

Experience: Communication

0% = “poorest”100% = “best possible”

90%

Experience: Clinical environment, access, facilities

0% = “poorest”100% = “best possible”

86%

Experience: Clinical competency

0% = “poorest”100% = “best possible”

88%

Experience: Overall satisfaction

0% = “poorest”100% = “best possible”

95% 87% 85%

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Foot Health Score

•Gain reduces with age•Patient groups likely to be more significant than age

Low volume bands excluded

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Patient Experienc

e

•High scores generally

•Recall of being provided with information lowest

•Further breakdown by location, staff etc. valuable

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Project scope ALL patients going

through prevention team 1000 patients over 5 weeks

in Sept/Oct 2010 Measures:

generic health foot health patient experience Health advice reception &

impact + continuous daily

feedback from patients

Responses 560 returned, 56% response

rate 2% on-line 98% on paper

Consistent response rate across service

Solent Healthcare (Portsmouth) PodiatryMathew King – Project lead

12CoMetrica © 2010

Overall resultsScale At treatment

startAfter 90 days

Responses n 178 189

Average resultsGeneric health PROM – EQ5D 5

0= feel like “death”1= perfect health

0.50 0.57

Foot health PROM - FHS

0= maximum pain, mobility restriction1=no pain, concern, restriction

0.51 0.58

Clinical Competency perceived

0% = “poorest”100% = “best possible”

84%

Experience: Overall satisfaction

0% = “poorest”100% = “best possible”

91% 93%

Health Advice (only for relevant patients) Motivational Made a difference

Diabetes Explanations understood of impact & specific care advice given

79%

Smoking 53% 50%Weight Management 68% 0%

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Foot Health Score 2

•Marked improvement in all areas

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Detailed reports

•Demonstrating reduction in pain frequency as a result of treatment

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Foot Health Score 2

•Change in foot health by department’s own severity/ treatment classification

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Patient Experienc

e

•Can review by:

•Location•Staff•Pt Age•Category•Treatment

Clinic A Clinic B Clinic C Clinic D Clinic E Clinic F Clinic G Clinic H

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Highly visible patient engagement, inclusive reach

No front line effort, standard reports save time

Continuous results linked to patient data

Operational qualitative tool – daily feedback

PROMS & benchmarks are powerful commissioning

levers

Differential value by patient groupings evident-

prioritisation?

Conclusion

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Thank you

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