Doubts over patient reports for QOF

Plans for the quality framework to incorporate reports by patients on how their health has improved could prove tough to implement, experts say.

Patient reported outcome measures (PROMs) are far easier to put in place in secondary care, where the NHS is implementing them first, according to the Picker Institute.

Dr Angela Coulter, chief executive of the institute, a charity that works to promote understanding of patients' perspectives, said at a conference on PROMs last month that the government was 'starting at the easy end'. She said that despite some challenges, it was not difficult to see how the measures would be introduced for elective surgery, as will happen next April.

'It's going to be much more tricky when we come on to long-term conditions,' she said. 'For some long-term conditions, the goal of treatment is not to cure but to maintain at a stable level.

'The aim may be to improve symptoms. With some long-term conditions, people will be declining, and that's to be expected, but you might be trying to ameliorate the decline. So that makes it a very different proposition.'

Dr Coulter said it was vital to collect data in a user-friendly way. To be useful to clinicians and patients, she said, 'electronic data should be introduced directly into the patient record with no need for data entry'.

Simple and intuitive patient reporting systems could allow patients to input data directly, which could be particularly relevant for those with long-term conditions, she added.

'You could do this in general practice with patients who you are seeing quite a lot. The idea is that each time you see them, they fill this in and then you can get a score which will tell you whether the patient is feeling better or not.

'The clinician and the patient can together review the scores to discuss the outcomes of treatment, if treatment needs to be adjusted, and so on,' she said.

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