The development of a prom for long term conditions

THE PROBLEM

Enabling patients to live well with long-term conditions (LTC) is a goal of the NHS Outcomes Framework[1] (Domain 2). Understanding the experience of patients is a crucial part of supporting this goal as well as providing quality health and social care.

A standardised questionnaire, called a Patient-Reported Outcome Measure (PROM), known as the ‘EQ 5D' is commonly used to capture this type of information from patients with long-term conditions.

However, the EQ 5D has only five questions and does not address many important aspects of living with long-term conditions, such as multimorbidity (having multiple health conditions at the same time).



[1] http://content.digital.nhs.uk/nhsof

The CLAHRC and its partners have developed improved methods for capturing, analysing, combining and communicating the evidence of patients’ outcomes and experiences via the creation of two new robust PROMS:

The Musculoskeletal Health Questionnaire (MSK-HQ)

This new PROM is tailored to work across all musculoskeletal conditions (those which effect the joints, bones and muscles, as well as some rarer autoimmune diseases and back pain).

The Long-term Conditions Questionnaire (LTCQ)

This is a new generic PROM, designed to work across all long-term conditions (physical and/or mental health including multi-morbidity) and to be applicable within a range of services, including primary care and social care.

The LTCQ could be used as a stand-alone measure or as a complement to existing measures, to fully capture what it means to ‘live well’ with long-term conditions.

Using the information obtained in these PROMS can help to redesign, renew or refine services, improving the quality of health and social care.

MSK-HQ

The MSK-HQ is available for licencing through Oxford University Innovation. [1]

Since the publication[2] of its validation study in August 2016, a new partnership model for implementing the MSK-HQ across different services has been developed. The MSK-HQ itself and the implementation model serve as leading examples of how patient-reported measures could drive quality improvement within routine clinical practice.

This has led to a further grant awarded by ARUK[3][4], to Keele and Oxford Universities to develop and implement an electronic intervention which includes the MSK-HQ to support clinical care, further broadening its reach and impact across more services.

LTCQ

The LTCQ is already being used as an outcome measure in the NIHR-supported Feeling Safe Study[5] of management of schizophrenia and is being trialled for use in dementia services[6][7].

Several NHS trusts have expressed interest in its use for planning and evaluating services and the CLAHRC is currently in discussions with its host trust (Oxford Health NHs Foundation Trust) to explore embedding these measures into the STP’s in our region.



[1] https://innovation.ox.ac.uk/outcome-measures/musculoskeletal-health-questionnaire-msk-hq/

[2] Hill JC, Kang S, Benedetto E, Myers H, Blackburn S, Smith S, Dunn KM, Hay E, Rees J, Beard D, Glyn-Jones S. Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ open. 2016 Aug 1;6(8):e012331.

[3] http://www.arthritisresearchuk.org/research/grant-tracker-items/2017/aiming-for-patient-centred-treatment-through-use-of-the-arthritis-research-uk-musculoskeletal-health.aspx

[4] http://www.arthritisresearchuk.org/research/news-for-researchers/2017/march/health-services-research-awards-announced.aspx

[5] Freeman D, Waite F, Emsley R, Kingdon D, Davies L, Fitzpatrick R, Dunn G. The efficacy of a new translational treatment for persecutory delusions: study protocol for a randomised controlled trial (The Feeling Safe Study). Trials. 2016 Mar 11;17(1):134.

[6] http://www.hra.nhs.uk/news/research-summaries/patient-and-carer-well-being-in-memory-clinics/

[7] http://www.pssru.ac.uk/blogs/blog/living-with-long-term-conditions-validation-of-the-long-term-conditions-questionnaire-ltcq/