Debate & Analysis: Can the outcome of primary care be measured by a patient reported outcome measure?

摘要

There is increasing interest in using Patient Reported Outcome Measures (PROMs) as an indicator of the effectiveness of health care, underpinned by the principle that the patient's experience of outcome, as opposed to the absence of disease, is a key measure of success. Most PROMs do not measure outcome directly, but collect patient self-reported health status before and after an intervention or episode of care, with the change between the scores providing the outcome. Measuring outcome in the unselected population seen in primary care requires a PROM which is applicable across a range of conditions, that is, generic. There are numerous generic PROMS, of which the most widely used in the UK is the EuroQoL group's EQ-5D. This measures health status through five tick-box questions on mobility, self-care, usual activities, pain/ discomfort, and anxiety/depression. It is recommended by the National Institute for Health and Care Excellence [NICE) for deriving quality-adjusted life years to assess the cost-effectiveness of interventions and is currently used to collect data on the outcomes of hip and knee replacements, and surgery for groin hernia and varicose veins.2 Globally, the most commonly-used generic PROM is the Short Form (36) Health Survey (SF-36).