Clinicians' and patients' views of metrics of change derived from patient reported outcome measures (PROMs) for comparing providers' performance of surgery.
BACKGROUND
Patient reported outcome measures (PROMs) are increasingly being used to compare the performance of health care providers. Our objectives were to determine the relative frequency of use of different metrics that can be derived from PROMs, explore clinicians' and patients' views of the options available, and make recommendations.


METHODS
First a rapid review of the literature on metrics derived from two generic (EQ-5D and EQ-VAS) and three disease-specific (Oxford Hip Score; Oxford Knee Score; Aberdeen Varicose Vein Questionnaire) PROMs was conducted. Next, the findings of the literature review were mapped onto our typology of metrics to determine their relative frequency of use, Finally, seven group meetings with surgical clinicians (n = 107) and six focus groups with patients (n = 45) were held which were audio-taped, transcribed and analysed thematically.


RESULTS
Only nine studies (9.3% of included papers) used metrics for comparing providers. These were derived from using either the follow-up PROM score (n = 3) or the change in score as an outcome (n = 5), both adjusted for pre-intervention score. There were no recorded uses of the proportion reaching a specified ('good') threshold and only two studies used the proportion reaching a minimally important difference (MID).Surgical clinicians wanted multiple outcomes, with most support expressed for the mean change in score, perceiving it to be more interpretable; there was also some support for the MID. For patients it was apparent that rather than the science behind these measures, the most important aspects were the use of language that would make the metrics personally meaningful and linking the metric to a familiar scale.


CONCLUSIONS
For clinicians the recommended metrics are the mean change in score and the proportion achieving a MID, both adjusted for pre-intervention score. Both need to be clearly described and explained. For patients we recommend the proportion achieving a MID or proportion achieving a significant improvement in hip function, both adjusted for pre-intervention score.
Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Zoe
Z
Hildon
Jenny
J
Neuburger
Dominique
D
Allwood
Jan
J
van der Meulen
Nick
N
Black
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000523:psychology / Q000601:surgery / Q000628:therapy; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000601:surgery / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000379:methods; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D057566:Self Report; D012720:Severity of Illness Index; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014648:Varicose Veins / Q000523:psychology / Q000628:therapy