A guide to PROMs methodology

Patient Reported Outcome Measures (PROMs) measure health gain in patients undergoing hip replacement, knee replacement and up to September 2017, varicose vein and groin hernia surgery in England, based on responses to questionnaires before and after surgery. This provides an indication of the outcomes or quality of care delivered to NHS patients and has been collected by all providers of NHS-funded care since April 2009.

PROMs comprise a pair of questionnaires completed by the patient, one before and one at least six months after surgery. Patients’ self-reported health status (sometimes referred to as health-related quality of life) is assessed through a mixture of generic and condition-specific questions.

For each patient, the PROMs dataset includes the following:

• patient-identifiable information, which is used for linkage purposes and not made available for wider analysis
• a condition-specific measure of self-reported health status
• generic measures of self-reported health status
• additional questions about the patient’s own health, including whether they have pre-existing conditions such as arthritis or diabetes

Analysis of the differences between the pre-operative and the post-operative PROMs data can be used to determine the outcome of the operation as perceived by the patient in terms of its impact on their self-reported symptoms and functional status.

To add to the value of the PROMs questionnaire data, they are linked routinely with Hospital Episode Statistics (HES) episode-level information.

Before a patient undergoes one of the PROMs procedures, the provider should offer the patient a PROMs questionnaire for completion. The guidance states that this should happen in the interval between the patient being passed fit for surgery and the treatment taking place. However, there is local discretion as to when precisely it is administered before the procedure. Completion of the pre-operative PROMs questionnaire is voluntary for the patient and their consent to participate must be granted for the data to be processed and used.

The completed pre-operative PROMs questionnaires are transferred securely to the accredited suppliers responsible for collating the information, where the forms are scanned electronically and traced to obtain the patient’s NHS number.

In a separate database the pre-operative PROMs questionnaires are linked securely to the HES database.

The accredited supplier posts out the follow-up post-operative questionnaire to the patient’s home. Once the form has been completed by the patient and returned, it is electronically scanned and linked with the pre-operative data along with HES, if applicable.

After the consent period has expired, the personal data are securely removed from the PROMs database and the data are pseudonymised.