The time has come to measure patient outcomes achieved by the UK National Health Service as a matter of routine practice nationwide, and it should be possible to do this for the majority of NHS activity within five years, the industry-backed Office of Health Economics Commission on NHS Outcomes, Performance and Productivity has reported.

The NHS receives well over £100 billion of taxpayers’ money per year and this amount has been growing 10% annually, yet we know remarkably little about how much our health is being improved as a result of such massive expenditure and effort, says the Commission, which was set up by the OHE in third-quarter 2006 to examine which patient outcomes data the NHS could, and should, be collecting.

Until recently, most attempts to assess NHS performance in terms of outcomes and productivity have been frustrated by severe limitations in the scope, quality and timeliness of data, but this situation is now changing dramatically, said Commission chairman Professor Peter Smith, of the University of York’s Centre for Health Economics.

“The IT revolution is making it feasible to capture a previously unimaginable range of information about the inputs, processes and outcomes of health care. Furthermore, an increasingly challenging public is demanding greatly improved accountability in exchange for the massive levels of taxes it invests in the health system,” he added.

The Commission welcomes as a “breakthrough” the requirement that NHS providers of elective hip and knee replacements, groin hernia surgery and varicose vein procedures should, from April 2009, collect and report patient reported outcome measures (PROMs) for these treatments but, it adds: “it is practical, and highly desirable, to go much further than that, and soon.”

For the report, Commission members reviewed the evidence on measures of patient outcomes in four disease areas – elective surgery, mental health, chronic obstructive pulmonary disease and colorectal cancer - which together cover acute and long-term conditions, primary care and hospital care, life-extending and quality-of-life-improving care. They looked at both disease-specific measures and “generic” measures of health-related quality of life – before, during and after treatment - which are designed to be completed by patients. Theey widely used in research but not, so far, in routine health service provision.

From their consideration of this evidence, the Commission members have recommended that:

- for elective surgery, both disease-specific and generic outcome measures should be collected before and after surgery, and this should spread to all common elective surgical procedures over the next three years;

- both generic and disease-specific measures should be collected at routine intervals for patients suffering from chronic diseases such as COPD. Pilot schemes should be conducted, in COPD for example and, if successful, these should then be rolled out from April 2010 to all providers and commissioners managing COPD patients, and subsequently to other chronic disease areas over the following years. This will involve collecting outcomes data in general practice surgeries as well as hospitals;

- for cancer patients, a similar approach involving pilots for one type of cancer (colorectal) is recommended, rolling out if successful to all providers and commissioners from April 2010, and then extending to all cancers over the following years; and

- for mental health, the Commission recommends use of disease-specific measures of patient outcomes before and after major interventions and on a periodic basis, but adds that further research will be needed to identify a generic measure of health-related quality of life that is suitable for mental health patents.

Buy-in essential
There are implementation issues – active support will be required from all stakeholders, says the Commission. Buy-in by clinicians is essential – if they do not see the benefits of measuring outcomes in their day-to-day work, collection of adequate outcomes data is unlikely to flourish. For patients, particularly those with chronic diseases, the use of outcomes data may help them to be able take a more active role in their treatment, but asking them to assess what health care has done for them “needs to be easy and quick,” the report stresses.

Discussing the findings with journalists at the report’s launch on Tuesday, OHE director and Commission member Professor Adrian Towse said he hoped they would help accelerate existing projects to measure and analyse healthcare outcomes projects and make them more ambitious. The Commission study has also shown that this is “much more doable than people think,” and at low cost – around £3-£6 per patient, and that the potential gains are enormous, said Prof Towse.

“After a long period of gestation, it does now look as if the widespread and routine use of outcome measurement is a concept whose time has arrived,” said Prof Smith, adding: “I suspect that in 20 years’ time it will seem beyond belief that we struggled for so long to steer out health system in the absence of any clear idea of what it was achieving.”