Producing a data-inputting and analysis calculator to facilitate the standardisation of outcome measures
The advantages for using patient-reported outcome measures (PROMS) have been well documented in the literature. The need for physiotherapists to use standardised PROMS has been recognised and is recommended in clinical guidelines. Although the importance of standardising the use of PROMS within the physiotherapy profession is well recognised, it has largely failed to be delivered in practice. A number of barriers for implementation of standardised outcome measures has been reported including the lack of knowledge and the lack of instructions in relation to the application, scoring and interpretation of the outcome measure(s).
Musculoskeletal (MSK) physiotherapy teams within Staffordshire and Stoke on Trent Partnership Trust (SSOTP) used a variety of outcome measures including the EuroQol (EQ-5D-5L) alongside condition specific PROMS and a patient experience-reported experience measure, in line with CSP recommendations. Nevertheless, the teams did not use the same outcome measure and data collection, inputting and analysis methods varied considerably. Therefore, the use of outcome measures and data collection needed to be standardised.
A consensus group exercise took place in order to choose an agreed outcome measure. Once the outcome measure was chosen the calculator was designed and developed by the authors based on the feedback received from physiotherapy operational and clinical leads. It was agreed that the calculator should capture patient specific data as well as condition specific data and it should highlight the minimal clinical significant difference based on the pre and post treatment outcome score.
The MSK health questionnaire (HQ) was chosen to be used across SSOTP. The calculator included the following fields: patient's NHS number, date of birth, postcode (linked to electoral wards), symptoms duration and location, clinical diagnosis/impression, clinician's name and banding, outcome of treatment on discharge (e.g. treatment completed and discharged, onward referral, etc.) and MSK HQ pre and post-treatment data and results including minimal clinical significant change when appropriate. Other outcome measures (visual analogue scale for pain and patient specific functional scale) that some teams had to collect due to pre-existing key performance indicators contractual agreements were also included. A data-inputting collection sheet was developed so that data inputting is performed by administrative staff.
The development of the outcome measure calculator facilitated the implementation of a standardised outcome measure (MSK HQ) and routine data collection on demographics, socioeconomic and health condition specifics, within the MSK Physiotherapy services across Staffordshire and Stoke on Trent Partnership Trust (SSOTP).
The outcome measure calculator may be adapted by other (physiotherapy) musculoskeletal services. The calculator enhances the implementation and clinical use of a standardised outcome measure by providing clear guidance on data collection and interpretation of results. Further work is needed to link the calculator with the electronic patient record system, which will simplify the data collection.
Top three learning points
- The introduction of a data inputting and analysis system can enhance clinical outcome implementation.
- Clinical engagement is essential in designing such a system.
- Frequent communication with all clinicians involved and sharing data within the organisation strengthens outcome implementation.
The calculator was created while the authors were employed by Staffordshire and Stoke on Trent Partnership Trust.
Physiotherapy Frontline 17 October 2018, Issue 17
This work was presented at Physiotherapy UK 2017.
For further information contact Panos Sarigiovannis.