title: Should English healthcare providers be penalised for failing to collect patient-reported outcome measures? A retrospective analysis.
abstract: OBJECTIVE
  The best practice tariff for hip and knee replacement in the English National Health Service (NHS) rewards providers based on improvements in patient-reported outcome measures (PROMs) collected before and after surgery. Providers only receive a bonus if at least 50% of their patients complete the preoperative questionnaire. We determined how many providers failed to meet this threshold prior to the policy introduction and assessed longitudinal stability of participation rates.
  
  
  METHODS
  Retrospective observational study using data from Hospital Episode Statistics and the national PROM programme from April 2009 to March 2012. We calculated participation rates based on either (a) all PROM records or (b) only those that could be linked to inpatient records; constructed confidence intervals around rates to account for sampling variation; applied precision weighting to allow for volume; and applied risk adjustment.
  
  
  METHODS
  NHS hospitals and private providers in England.
  
  
  METHODS
  NHS patients undergoing elective unilateral hip and knee replacement surgery.
  
  
  METHODS
  Number of providers with participation rates statistically significantly below 50%.
  
  
  RESULTS
  Crude rates identified many providers that failed to achieve the 50% threshold but there were substantially fewer after adjusting for uncertainty and precision. While important, risk adjustment required restricting the analysis to linked data. Year-on-year correlation between provider participation rates was moderate.
  
  
  CONCLUSIONS
  Participation rates have improved over time and only a small number of providers now fall below the threshold, but administering preoperative questionnaires remains problematic in some providers. We recommend that participation rates are based on linked data and take into account sampling variation.
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK nils.gutacker@york.ac.uk.
authors.forename: Nils
authors.initials: N
authors.lastname: Gutacker
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Street
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gomes
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Bojke
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000592:standards*; D019645:Arthroplasty, Replacement, Knee / Q000592:standards*; D003625:Data Collection; D004739:England; D019983:Guideline Adherence; D006291:Health Policy; D006761:Hospitals / Q000592:standards*; D006801:Humans; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D013222:State Medicine; D011795:Surveys and Questionnaires
keywords: best practice tariff; financial incentives; patient-reported outcome measures; response rates
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