Protocol for a Realist and Social Return on Investment evaluation of the use of Patient Reported Outcomes in Value Based Healthcare Programmes

Value Based Health Care (VBHC) is a list of ideas and actions seeking to provide every individual with the best care possible. People complete questionnaires called Patient Reported Outcome Measures (PROMs). Different health conditions require different questions. Developing the ways we measure and use PROMs may improve peoples’ lives. Realist evaluation and Social Return on Investment (SROI) Value is more than just cost. Value represents a relationship between what we use (knowledge, people, funds, activities) and what happens in different contexts to achieve the desired outcomes from the perspective of patients and clinicians. Realist methods will be used to explore these relationships. SROI seeks to identify changes that are often unrecognised and unmeasured. SROI measures changes that are important to the organisation and the individual.

Using this framework, SROI measures social and environmental costs as well as economic costs.

Objectives

We need to:

- discover whether the PROMs we are using measure what matters to individuals and also whether we can reliably measure change with these tools.

- identify whether collecting PROMs leads to improvement in patient care. This might include i) more timely care, ii) care closer to home iii) direct referral to relevant health professionals, iv) avoiding unnecessary hospital visits vi) prevent unplanned admission.

- measure the overall value of collecting PROMs; is it of sufficient value that routinely collecting PROMs is worth the time and resource?

- understand why some people do not complete PROMs. We need to ensure that everyone who might benefit has access. People must not be excluded because of poverty, deprivation, age or any other characteristic.

What we will do

We will review the PROMs programme in ABUHB to better understand how things are supposed to work in an ideal world. We will focus specifically on three service areas, namely, epilepsy, Parkinson’s disease (PD) and cataracts.

We will analyse documents and processes, undertake a questionnaire survey, and interview patients/carers and professionals to see how this translates into practice. We will undertake an SROI of using PROMs.

What We Hope to Discover in Epilepsy, PD and Cataracts

In epilepsy, we know that depression is linked to seizures. We seek to discover if using PROMs leads to earlier diagnosis and treatment of previously undiagnosed mood disorder In PD, PROMs capture abnormalities in movement, swallowing and mood. Scores may help determine whether the patient needs changes in medication or referral to therapies.

Use of PROMs may enable people to get care that is tailored to their needs, instead of the default position of seeing people at a fixed time interval. We know that people who receive cataract surgery do not all achieve the same improvement. Cataract PROMs help to determine how well a person functions in the world before surgery. This can prevent the harm of unnecessary surgery and reduce the demand for surgery.

Public Involvement

The research is co-produced with patient groups from inception to dissemination. Dissemination ABUHB is serving as a pilot site for the national VBHC programme who are seeking to replicate this work across Wales. We will report our findings to funding bodies, the Welsh Government, particularly the Wales VBHC, National conferences in epilepsy, PD and Ophthalmology, Citizen Panels, Partnership Boards and publish in academic journals.