By Rebecca Lafferty, National PROMS Network Co-ordinator and Outcomes Manager (Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust).
Outcomes data collection can mean different things to different people. It depends on the provider and how the data collection process is set up. In some units, the data collected contributes to a bigger picture through national data sets such as the NJR, NLR and NAHR. In other cases, one or two consultants who are particularly interested in a sub group of patients, collect data on a smaller scale. It’s a growing area of interest and there are many projects looking at operation or intervention recording and patients’ pre and post op scores to assess their outcome.
At Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (WWL) we have an outcomes data collection unit which looks after all the data collection for the national registries, along with in-house collection in line with NICE guidelines. In both cases, this is done as a unit approach and we are now in a position to start to look at our data as a unit and start to compare that with national data sets. This can be used for a range of purposes such as surgeon appraisal and setting best practice – but it also gives us the ability to look at patient care by examining the individual’s progress.
From my personal experience, working with orthopaedic consultants and data collection pathways, there is genuinely a lot of interest in collecting data in the specialty (though there are consultants that have less desire to collect PROMs or any kind of outcomes data). In order to successfully set up data collection pathways, it needs to be a process that does not involve heavy input from the consultant – this gives it a better chance of becoming automated and normal practice. In order to support this going forward, national bodies such as the National Orthopaedic Alliance (NOA) and National PROMs Network, need to help and guide providers that are trying to improve data collection. Both the NOA and PROMs Network have identified work streams to enable better collection. As part of the work going on within the PROMs Network, a national audit is being undertaken which will provide a picture on which sites are collecting PROMs data and how.
It’s hard to talk about improving data collection without mentioning administrative support – a role that cannot be underestimated. Outcomes data collection generally includes a pre op score, an operation/ intervention and a post op score. This can be supported with IT solutions and in time can be automated, but in order to bring it all together, a co-ordinator role is extremely valuable. With this support, the process does not have to rely on clinician time to gather data and will encourage a unit level data collection.
The process, of course, would need clinical support and guidance, but consultants collecting outcomes scores in clinic, when they can, is not a practical long term solution if this data is to be taken seriously in the long term. Orthopaedic surgery for many patients is life changing – it can relieve pain and improve physical function. It’s important that we are able to effectively demonstrate value to them by assessing and recording the results of surgery via effective outcomes pathways and processes. Work to perfect this in orthopaedics continues and I am encouraged by the various projects and initiatives that are ongoing.
Rebecca Lafferty is National PROMS Network Co-ordinator and Outcomes Manager at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust. Rebecca has worked at Wrightington hospital for nearly 10 years and had various roles within the data collection department. More recently she has taken on the role of managing the outcomes unit based at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust. During 2020 she became more involved with the National PROMs Network and developing this forum. Rebecca recently secured a project manager role within Greater Manchester that aims to deliver hip and knee PROMs across the city.