Patient-reported outcome measures (PROMs) are recognized as a viable means of valuing health care interventions. Such measures are being applied in a large scale, system-level study taking place in Vancouver, Canada (VALHUE) aimed at evaluating the changes in patients’ health statuses pre/post elective surgery. This required identifying and selecting PROMs instruments that were supported by a health status classification system and allowed for both intra- and inter-condition comparisons. The purpose of this study is to report on the development of a selection framework and our review of PROMs instruments.
Methods:
VALHUE encompasses 49 unique elective surgeries in 9 different surgical specialties. In order to systematically review PROMs instruments for these surgeries, we developed an evaluation framework. This framework included: 1) ability to rank order health states, 2) measurement system/analytic framework for intra/inter-condition comparability, 3) availability of population norms, 4) perceived respondent burden, and 5) affordability. We then searched the literature to identify relevant generic and condition-specific PROMs instruments.
Result:
Generic health status instruments were easily identified and information pertinent to our framework was sourced from a rich body of research. Generic instruments for general state of health (EuroQoL EQ-5D), pain (PEG), and depression (PHQ-9) were confidently incorporated into the VALHUE study. Condition-specific instruments, on the other hand, were far more challenging. For all but a few high-volume surgeries, existing PROMs instruments are for diagnosis rather than classification purposes. Consequently, the ability to rank order or compare health states is lacking. Population norms are also rarely available. Many of the condition-specific instruments have a large number of questions. Few are associated with any licensing costs.
Conclusion:
PROMs could be an important and promising tool in characterizing the utilization and effectiveness of different surgical interventions. Internationally, policymakers are increasingly incorporating these measures into their health reform efforts. But to do this on a population-level requires a rigorous measurement and classification system. Based on our review of available instruments, the majority of generic health status instruments could be implemented with confidence. Condition-specific instruments, however, still suffer limitations and require considerable work if they are to be adopted for measuring value delivered by a health care system.