Value-Based Health Care: What's in it for patients?
VBHC is helping to reorient health services to become focused on Patient-Reported Outcome Measures (PROMs). By defining and collecting PROMs via digital health assessments clinicians can improve direct patient care and make services better for the population.
Patients will contribute to this by completing questionnaires either in clinics or at home. These questionnaires are short, structured assessments that communicate how a person is feeling on that day in relation to their condition and overall quality of life. This data empowers patients and clinicians to make informed decisions. For example, it can influence the choice of treatment or determine whether a patient needs to attend a clinic in person. VBHC enhances shared decision-making and improved person-centred care.
In building systems to collect and analyse this information, NHS Wales has invested in technologies that radically improve communication with patients. These systems are used by some services to enable telemedicine.
Using smartphones and tablets, patients can communicate with clinical teams remotely about their health. This presents opportunities to access care quickly if needed. It also saves patients the time, inconvenience and expense associated with travelling to unnecessary clinic appointments.
Better services for all
VBHC will drive decision-making in NHS Wales. It will help to determine where investment adds most to improving patient outcomes, and where it does not. Using resources well is vital to ensuring services deliver what patients want in a sustainable way. By making services more efficient, the experience of all patients will be improved – for example, by reducing waiting lists and prioritising those with the greatest need first
Patient data can also be used for research purposes. While ensuring privacy and data security, large datasets can help clinicians and service planners understand the patient need and how best to deliver value. This contributes to a smarter, data-driven NHS Wales for everyone.
“We are not familiar with doing things online and completing a PROMs form by telephone is fun, interesting and a pleasure. I do get comfort from the call and we feel we are treated with dignity
Cardiology patient, Swansea Bay University Health Board
Value-Based Health Care: What does it mean for clinicians?
Clinicians can maximise the impact of their patient contacts by reviewing PROMs collected remotely, use data to trigger behaviour changes, and highlight areas where investment will deliver value for patients
The tools used to collect PROMs are chosen by our clinicians to ensure they are well-suited to the needs of patients using NHS Wales’s services. Our clinical teams can review PROMs before a patient visits the clinic, helping to make appointments more efficient and to identify areas in need of attention.
PROMs data can help to prioritise patients with the greatest need, helping to make the best use of clinic time. This allows urgent cases to be identified and fast-tracked while easing pressure on services by reducing unnecessary in-person follow-up appointments. Opportunities to focus on necessary follow-up appointments offer greater job satisfaction to our busy clinical teams.
Data dashboards
Our data specialists are working with clinical leads to build data dashboards that help our busy frontline staff to visualise key PROMs data for individual patients. These dashboards are tailored to the needs of doctors and nurses who use them. In some disease areas, clinical teams prefer data to be presented in graphical form, with colour-coded information or as an aggregate score representing how the patient is doing.
Pooled data from large numbers of patients will offer insights that can drive patient-clinician conversations about treatment options or lifestyle changes. Using data from Wales, it will show the patient the likely outcomes for a typical person like them. This can guide patient expectation and motivate some to take actions that would improve their outcomes – such as smoking cessation, exercise or improved diet.
PROMs can be invaluable to help optimise outcomes at several levels:
For an individual patient, they enable the clinical team to focus on what matters to the patient. Aggregated PROMS data can offer an individual patient a basis for decision-making about their own care, based on the experience of others suffering from a similar condition.
For a patient cohort, they give data which may form the basis of improvements to patient pathways, the outcomes of specific treatments, and the appropriate selection of patients for such treatments.
At the health board & population level, PROMS data could enable more efficient & effective care and reduction of expenditure on low-value interventions. Opportunities would be created for further investment in treatments that do demonstrate value in health care.
Dr Susan Goodfellow, Clinical Improvement Lead for Value-Based Healthcare
Clinicians will also benefit from a deeper data-driven understanding of the services and interventions they provide. Equipped with data about service needs and the value of available interventions, clinicians can refine how they deliver care and make the business case for reallocating resource or for further investment.
What are PROMs?
Patient-Reported Outcome Measures (PROMs) are questionnaires that have been designed and tested with patients and clinicians for either specific diseases or for your general health and quality of life. They look for changes in people’s health before and after treatment and/or overtime to understand changes in people’s quality of life.
An example of the EQ5D 5L general health/quality of life questionnaire.
PROMs questions are usually multiple-choice, with most questionnaires having a scoring system which converts answers into a single score. Each PROM may have a different number of questions, and scoring system, with answers to different questions being weighted according to their importance.