What are patient reported outcome measures (PROMS) ?

The success of surgical outcomes, such as knee replacement surgery is measured in 'hard' outcome measures and 'soft' outcome measures.

Hard outcome measures tend to be patient questionnaires and patient scores (for example, the Oxford Knee Score, the SF36, the EQ5D and the 'Forgotten Knee Score') which are a series of questions designed to work out how much pain, deformity and loss of function a patient has and how much they have improved after surgery.

Soft outcome measures and patient feedback are often displayed on digital review platforms but these can often be limited or 'showcase' highly positive reviews. The most trustworthy outcome measures are therefore Patient Reported Outcome Measures (PROMS) as collected by an independent body such as the National Joint Registry.

Transparency in outcomes for knee replacement surgeryTransparency in healthcare outcome data

There is a drive towards more transparency in health care and both individual practices and hospitals are collecting soft and hard data from their patients to make sure that their operations and interventions have really worked. On some reporting systems patient feedback are often displayed on digital review platforms, but often only seem to showcase the highly positive reviews. 

The most trustworthy outcome measure are therefore PROMS collected by an independent body such as the National Joint Registry (NJR).

In August 2020, the National Joint Registry, started giving individual surgeons feedback on their own PROMS performances, from data that had been collected over the last decade.

Insider information on professional surgical outcomes

Knee replacement performance outcome funnelThis information is not publically available, but can be requested from your surgeon, who should be happy to provide you with it. The report will generally tell you whether the National Joint Registry’s data indicate whether an individual surgeon’s PROMS have improved following knee replacement surgery. 

(NB this extra paragraph is an editorial comment from Total Health) The yellow dot on the plot of all surgical outcomes (see graph) marks Mr Rajaratnam's own position in terms of improvement on Oxford Knee Score following knee replacement surgery - as recorded by the NJR over the last decade. His position demonstrates a "significant positive outlier at the third standard deviation". In other words, he is evidently and demonstrably one of the top performers in the UK.

My PROMS outcome data for knee replacement surgery

The following graph depicts my own patient reported outcome measured data on the National Joint Registry.

Knee replacement surgery PROMS
Knee replacement surgery PROMS for Mr Sam Rajaratnam


It is worth noting that the Apperta Foundation have also considered PROMS to be a priority for inclusion on the new open source 'openEHR' system. Apperta say that some NHS trusts now routinely collect questionnaires to compare patients’ pre-operative and post-operative scores to inform clinical practice and drive improvement. The NHS Trusts currently collect the data in paper format which is then converted into an electronic format for storage and analysis purposes (usually via manual input). However, with openEHR the data will now sit either in fully compliant cloud-based servers or within a trust’s own environment meeting all industry standards for security and GDPR.

The data will facilitate data analytics and will be designed to interoperate with other hospital systems. Trusts have full real time access to their patient data for analysis, data is protected as per the trusts governance policies.

Apperta say, "There is variability in outcomes, which can depend on patient factors but can also depend upon the surgical teams that perform the surgery. So that any variability in outcomes in patient groups can be studied and improvements in care made".

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