Protocol for a Realist and Social Return on Investment evaluation of the use of Patient Reported Outcomes in Value Based Healthcare Programmes

End of project summary

Main Messages

As more people need healthcare, the NHS is looking for ways to improve how we use resources whilst also making things better for patients. Value-Based Healthcare (VBHC) is a model of healthcare that focuses on improving patient outcomes and experiences while minimizing costs. There is growing interest in the use of Patient Reported Outcome Measures (PROMs) to help achieve the aims of VBHC. PROMs are a group of questions created for patients and their healthcare team to assess and monitor health, treatment, and wellbeing. One of the main goals of PROMs in a VBHC context is to help achieve what matters most to patients within the available resources. However, there has been very little research evaluating how well PROMs work for both patients and healthcare services when implemented in a VBHC context. We used robust methods to understand how PROMs worked in four VBHC programmes in one Health Board. Specifically, we used a Realist Evaluation to understand how PROMs work, why, and for whom within a VBHC context; and a Social Return on Investment analysis to measure the social and economic value of PROMs for patients and healthcare services.

• PROMs added substantial value to Heart Failure services, working well for clinicians and services, ultimately improving the quality of care for patients and their families. This success provides an invaluable reference for future VBHC programmes.
• PROMs added no to little value to Parkinson's and Epilepsy services. This shows that PROMs might not work well in every situation. It is important to consider the resources available and how engaged clinicians are with the programme.
• None of the programmes resulted in better collaboration between patients and clinicians while considering patients’ needs and preferences. We must empower patients, ensuring they are better informed and active in their care.

We recommend that PROMs should be redesigned specifically for routine care, incorporating what matters most to patients. Patients and clinicians should be trained in how to use PROMs within VBHC. Patients should receive feedback on their PROM scores. IT systems should be integrated with patient records.