Evaluation of a new short generic measure of health status: howRu

Benson, Tim; Sizmur, Steve; Whatling, Justin; Arikan, Seref; McDonald, Dianna; Ingram, David

doi:10.14236/jhi.v18i2.758

Cited by 42 publications

(63 citation statements)

References 36 publications

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“…We asked teams if and how they assessed outcomes, and requested copies of documentation that was used. The teams described several tools they used for measuring 'outcomes' which were primarily physical, cognitive or emotional status measures, such as the Mini-Mental State Examination 87 or the Timed Up and Go, 88 or generic health outcome measures, such as the HowRU 89 and the European Quality of Life-5 Dimensions (EQ-5D). 90 This illustrates NRTs' everyday operational understanding and use of outcome assessment in practice.…”

Section: Profiles and Processesmentioning

confidence: 99%

Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care

Aspinal

Bernard

Spiers

et al. 2014

Health Services and Delivery Research

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BackgroundFailure to demonstrate the effect of integration on service users using conventional outcome measures suggests that research to date has failed to measure the outcomes that actually matter to people with complex long-term conditions and that might result from integrated health and social care. Developing outcome measures that capture the important issues for service users may also help to better reflect the particular ways integrated teams work and what such teams strive to achieve in addressing service user outcomes.ObjectivesThe objectives of this research were to (1) identify factors that affect integration between health and social care; (2) identify outcomes important to people with long-term neurological conditions (LTNCs) who are clients of an ‘integrated’ service; (3) develop these outcomes into a checklist and explore whether or not these outcomes can be assessed in practice; and (4) understand how different models of integration affect outcomes.Design, methods and participantsA case study approach, using in-depth, semistructured interviews, was adopted. The cases were four English primary care trusts (PCTs) and their associated local authorities. Case sites had a neurological-rehabilitation team (NRT), each with a different approach to health and social care integration. The research took place in three stages. In stage 1, interviews with 43 commissioners, managers, NRT staff and social care practitioners, and documentary analysis, helped to understand service contexts and approaches to assessment. Interviews, guided by earlier outcomes work, were held with 35 people with LTNCs to identify important outcomes. Interviews with 13 carers illustrated relationships between NRTs and carers. In stage 2, these outcomes were developed into a checklist in partnership with NRTs. NRTs used the outcomes checklist (OC) as part of their routine assessment, and we monitored its use. In stage 3, we conducted interviews and focus groups with 21 NRT staff and 12 clients to evaluate the use of the OC in practice.AnalysisQualitative data were managed and analysed thematically using the framework approach.ResultsPerson, service and structural-level factors influenced integration between health and social care. Relationships between practitioners and services often drove integration in practice. However, wider structural arrangements were important and could facilitate these relationships. We identified 20 outcomes important to people with LTNCs. These were grouped into three outcome domains: personal comfort, economic and social participation, and autonomy. Use of the OC in practice was viewed differently by the NRTs. One NRT felt that it duplicated existing assessments, one felt that it covered issues outside their remit and two felt that the OC worked for them. Some of the outcomes could be difficult for staff and clients to raise but clients felt that they should all be included in assessments. Use of the OC was sometimes challenging due to staffing and caseload pressures, changes to service structures and remit, and competing demands of other compulsory paperwork. All NRTs thought that the OC had potential value as a benchmarking or training tool. Larger, more interdisciplinary models of integrated NRTs appeared to give more scope for interpreting, assessing and potentially achieving outcomes.ConclusionsMany of the outcomes that are important to service users with LTNCs are not addressed in validated ‘outcome measures’. This has implications for commissioners and practitioners to ensure that service users’ needs are met in practice. Turning the OC into a measurement tool could go some way to addressing this. Many of the outcomes are interdependent; an impact on one particular outcome will have a ‘knock-on’ effect on other outcomes. These inter-relationships demonstrate the complexity of what is important in the lives of people with LTNCs. Service changes can affect integrated arrangements negatively. More research is needed to explore the longer-term effects of organisational change on integrated service provision.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Profiles and Processesmentioning

confidence: 99%

Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care

Aspinal

Bernard

Spiers

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

show abstract

“…The howRU is a short generic measure of health related quality of life that measures how the patient is feeling physically and mentally, and how much they can do in terms of function and independence. It was designed with electronic data collection in mind and has been validated against the Short form-12 (SF-12) (Ware et al, 1996) score at the aggregate level (Benson et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…At final review at 16 months (21 months following the initial injury) the patient was cycling regularly and reported further improvements in his symptoms. The OKS at this time was 37/48 with a howRU score of 10/12 (Benson et al, 2010). Table 1 Oxford knee score (OKS) (Dawson et al, 1998) and howRU (Benson et al, 2010) recorded over a 24-month period from the initial consultation 0 24 50 --3 27 56 --6 32 67 11 92 9 37 77 10 83 12 40 83 11 92 15 37 77 10 83 18 41 85 12 100 21 47 98 12 100 24 48 100 12 100 The patient was encouraged to monitor his clinical outcome scores beyond this final review and at 24 months the OKS was 48/48 and the howRU score 12/12.…”

Section: Case Reportmentioning

confidence: 96%

An acute knee injury: tracking a two-year recovery online

Taylor

Williams

2015

IJEH

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Current government policy aims to deliver high quality healthcare by recording accurate data at the point of giving care, storing it efficiently and displaying it in a format, which is easily interpreted by healthcare professionals and patients. Few published reports describe the benefits of collecting and reporting such data from the point of view of the patient. We report the case of a 62-year-old lorry driver who used a web-based system to track patient reported outcome measures (PROMs) following an acute knee injury to full recovery over a 24-month period. The system reports clinical outcome scores in real-time to the patient and their medical team, clearly illustrating and enhancing recovery from injury. This case reveals how local software meets the needs of the individual patient linking and integrating such local systems must be the future focus of eHealth within the NHS to release the benefits presented by the information revolution.

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“…[12][13][14] The howRU score is a generic wellbeing score, validated against the SF-12 ® (Short Form 12-item health survey) score, that rates four items ('pain and discomfort', 'feeling low or worried', 'limited in what you can do' and 'requiring help from others') to provide a score from 0 (low wellbeing) to 12 (high wellbeing). 13 Patient demographic details revealed that the overall mean age was 57 years (with no significant age difference between the groups) and that 75% of patients in the study had access to the internet (Table 1). All patients received a leaflet in clinic, encouraging them to register a score and read additional information (provided by NHS Choices) about their condition on the web-based system.…”

Section: Methodsmentioning

confidence: 99%

Use of SMS and tablet computer improves the electronic collection of elective orthopaedic patient reported outcome measures

Roberts

Bradley

Williams

2014

annals

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INTRODUCTION Electronic patient reported outcome measures (PROMs) enable real time reporting back to the patient and medical team, comparison between similar patient cohorts and long-term cost effective outcome measurement. The primary objective of this three-phase pilot study was to measure uptake using a web-based PROM system following the introduction of two separate process improvements. METHODS Eighty consecutive new elective orthopaedic patients in a single surgeon's practice were recruited for the study. Patients in Group 1 (n=26) received only a letter reminding them to complete a symptom score. Those in Group 2 (n=31) also received a reminder SMS (short message service) message via their mobile or home telephone and those in Group 3 (n=23) also had access to a tablet computer in clinic. RESULTS The mean patient age in Group 1 was 55 years (range: 24-80 years), in Group 2 it was 60 years (range: 23-85 years) and in Group 3 it was 58 years (range: 37-78 years) (p>0.05). Overall, 79% of patients had internet access, and 35% of Group 1, 55% of Group 2 and 74% of Group 3 recorded an electronic PROM score (p=0.02). In Group 3, 94% of patients listed for an operation completed an electronic PROM score (p=0.006). CONCLUSIONS Collecting PROM data effectively in everyday clinical practice is challenging. Electronic collection should meet that challenge and improve healthcare delivery but it is in its infancy. This pilot study shows that the combination of an SMS reminder and access to a Wi-Fi enabled tablet computer in the clinic setting enabled 94% of patients listed for an operation to complete a score on a web-based clinical outcomes system. Additional staff training and telephone call reminders may further improve uptake.

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Evaluation of a new short generic measure of health status: howRu

Cited by 42 publications

References 36 publications

Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care

Outcomes assessment for people with long-term neurological conditions: a qualitative approach to developing and testing a checklist in integrated care

An acute knee injury: tracking a two-year recovery online

Use of SMS and tablet computer improves the electronic collection of elective orthopaedic patient reported outcome measures

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