A series of maps published by The NHS Information Centre today highlight clear geographical variation in the extent to which patients feel they have benefited from their care.

Access the maps here

Taken from the report, Patient Reported Outcome Measures (PROMS) in England 2009/2010, the maps (attached) are based on the results of questionnaires completed by patients before and after they undergo surgery.

They show the average adjusted health gain for each procedure measured using the EQ-5D Index score. The difference between the two results indicates how much patients report benefiting from their surgery. The experimental report focuses on:

• hip replacements
• knee replacements
• groin hernia surgery, and
• surgery on varicose veins.

It uses five different scoring systems for evaluating patients' reports of their health before and after treatment. Two of these apply across all four procedures with the more detailed one - called the EQ-5D Index score – capturing the impact of treatment on a range of aspects of general health such as mobility, self-care, pain and depression. The other three systems are condition-specific.

Based on the EQ-5D Index score, the report shows:

• 87 per cent of hip replacement respondents recorded an increase in general health following their operation.
• This compares to 78 per cent of those who underwent knee replacement, 52 per cent who underwent varicose veins surgery and 49 per cent of those who underwent groin hernia surgery.

Chief executive of the NHS Information Centre Tim Straughan said: “This groundbreaking report shows the extent to which patients say they benefit from their treatment varies from procedure to procedure as well as from place to place.

“It is the first time that this type of data has been gathered on such a large scale and across a full year. We also have provisional data for 2010/11 – all of which will be of enormous interest to those planning services.”

The full 2009/10 report is at www.ic.nhs.uk/pubs/finalisedproms0910

Provisional data for 2010/11 is available from www.ic.nhs.uk/pubs/provisionalmonthlyproms.

Both sets of data are accompanied by interactive spreadsheets that enable users to compare both participation rates and scores of individual providers.

Also included is a funnel plot which allows users to compare the results of individual providers with national averages.

ENDS

Notes to editors

1. The NHS Information Centre for health and social care (The NHS IC) is England's authoritative, central, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researcher, regulators and policymakers in their work. The NHS IC also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
2. Before a patient undergoes one of the four PROMs procedures, the provider should offer the patient a pre-operative PROMs questionnaire for completion between the patient being passed fit for surgery and the treatment taking place. Completion of the PROMs questionnaire is voluntary for the patient and their consent to participate must be granted for the data to be processed and used.
3. Post-operative questionnaires are sent out to patients three months (for groin hernia and varicose vein surgery) or six months (for hip and knee replacement surgery) after the procedure date recorded on their hospital (HES) record. If the pre-operative questionnaire is not linked to HES and the procedure data is not available, the three- or six-month count is started 12 weeks after the scan date of the pre-operative questionnaire. The patient can then return the questionnaire at any time thereafter.
4. The PROMs programme utilises a number of tested and well-established methodologies to enable patients to rate their health status before and after their operation. 1) The EQ-5D Index score reflects general health status, capturing condition specific issues in a broad way through five weighted questions. This measure is more disaggregated than the alternative EQ-VAS score. 2) The EQ-VAS score asks patients to score their health on a scale of 0 (worse) to 100 (better) on the day that they complete the questionnaire and therefore provides an indication of the patient's health that may not necessarily be associated with the condition for which they underwent surgery and may be affected by factors other than health care. 3) The condition specific measures (Aberdeen Varicose Vein Questionnaire score and Oxford Hip and Knee scores) focus on clearly defined aspects of the patient's clinical condition which would be expected to be affected by their procedure. The Aberdeen Varicose Vein score, on a scale between 100 (worse) and 0 (better), is based upon 13 weighted questions specifically related to varicose veins. The Oxford Hip and Knee scores, on a scale between 0 (worse) and 48 (better), comprises twelve multiple choice questions including the patient's experience of pain, ease of joint movement and ease of undertaking normal domestic activities such as walking or climbing stairs
5. The maps: The average adjusted health gain is calculated using statistical models developed by contractors (CHKS Ltd in conjunction with Northgate Information Solutions Ltd) on behalf of the Department of Health as part of the PROMs programme. Although the methodology has been subject to quality assurance by the PROMs programme it should be noted that the methodology has not at this stage gone through the full NHS Information Centre's Indicator Pipeline assurance process as the methodology predates the process. The Pipeline is an independent process which provides additional scrutiny of methods used. Further information regarding the methodology can be found at: [http://www.northgate-proms.co.uk/documents.html] The maps are based upon modelled data. If an organisation has less than 30 full records, the model cannot be applied to produce an average adjusted health gain. The maps are a starting point for further investigation rather than giving a definitive conclusion on commissioner performance within an area. The ranges for each map are designed to include an approximately equal number of areas. A change in the range could cause a number of organisations to move to a higher/lower band. It is recommended that these maps are used in conjunction with the commissioner level tables and/or score comparison spreadsheet produced as part of the publication. The legend on each map identifies the range of average adjusted health gain for each colour code. For this measure (EQ-5D Index score), a higher adjusted average health gain show where patients feel that they have benefited most from their NHS treatment. The London area has been enlarged in order for that area to be seen more clearly. Due to geographical boundary changes, no map data is shown for Hertfordshire PCT. During 2009/10, Hertfordshire contained two separate PCTs, East and North Hertfordshire PCT and West Hertfordshire PCT. These PCTs merged in April 2010 into a single Hertfordshire PCT. A reference map and key has been provided in order to aid in the identification of PCTs.
6. Where percentages are given indicating how many patients reported a change in their general care following treatment, they are based upon the number of questionnaire pairs (pre and post-operative) where a change could be measured.
7. “Experimental statistics” are new official statistics that are under going evaluation. A key part of the “Experimental statistics” label is user engagement in the evaluation of those statistics. The NHS IC invites readers to comment on this publication, which will help inform the next report. Comments may be sent to enquires@ic.nhs.uk.
8. Any and all copyrights in the EQ-5D questions, their order, layout and images vest in the EuroQol Group. The EuroQol Group reserves all rights. © 1992 EuroQol Group. EQ-5D™ is a trademark of the EuroQol Group [http://www.euroqol.org]. Any and all copyrights in the Oxford Hip Score and Oxford Knee Score questions, their order and layout vest in Isis Innovation Limited. Isis Innovation Limited reserves all rights. © 1996 Isis Innovation [http://www.isis-innovation.com/licensing/healthoutcomes/oxford_hip_and_knee.html]. Except where expressly stated to the contrary, the Department of Health PROMs questionnaires are protected by Crown copyright. © Crown copyright 2008.
9. For further information, email mediaenquiries@ic.nhs.uk or call 0845 257 6990