An emerging framework for fully incorporating public involvement (PI) into patient-reported outcome measures (PROMs)

Patient-reported outcome measures (PROMs) are widely used in the United Kingdom (UK) and internationally to report and monitor patients’ subjective assessments of their symptoms and functional status and also their quality of life. Whilst the importance of involving the public in PROM development to increase the quality of the developed PROM has been highlighted this practice is not widespread. There is a lack of guidance on how public involvement (PI) could be embedded in the development of PROMs, where the roles can be more complex than in other types of research. This paper provides a timely review and sets out an emerging framework for fully incorporating PI into PROM development.

An updated systematic review of Health State Utility Values for osteoporosis related conditions

INTRODUCTION

An important component of cost effectiveness models in the field of osteoporosis is the set of Health State Utility Values (HSUVs) used for key fracture outcomes. This paper presents a review of HSUVs for key osteoporotic states (hip, wrist, shoulder, clinical, and morphometric vertebral fractures, established osteoporosis, and interaction of several fractures). It provides an update to the systematic review conducted by Brazier et al. (Osteoporos Int 13(10):768-776, 2002).

MATERIALS AND METHODS

A systematic search was undertaken of the main literature databases for HSUVs for established osteoporosis, vertebral, hip, wrist, and shoulder fractures were identified. Studies meeting the inclusion criteria were reviewed in terms of the patient population, the method of describing health (if not obtained directly from patients), the method of valuing health states and the source of values.

RESULTS

Estimates of Health State Utility Values were found across the osteoporosis conditions from 27 studies. A wide range of empirical estimates were found, partly due to differences in valuation technique (VAS, SG, TTO), descriptive system and differences in respondents (population or patient), the perspective of the task (own health or a scenario), sample size, and study quality.

CONCLUSION

The paper provides a set of multipliers representing the loss in HSUVs for use as a "reference case" in cost-effectiveness models.

Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care

OBJECTIVES

To compare the effectiveness and costs of a new domiciliary rehabilitation service for elderly stroke patients with geriatric day-hospital care.

DESIGN

Randomized controlled trial.

PARTICIPANTS

Stroke patients aged 55+ who required further rehabilitation after hospital discharge or after referral to geriatricians from the community.

SETTING

Poole area, East Dorset, a mixed urban/rural area on the south coast of England.

MAIN OUTCOMES

Primary-changes between hospital discharge and 6-month follow-up in physical function as measured by Barthel index. Secondary-changes over this period in Rivermead Mobility Index and mental state (Philadelphia Geriatric Centre Morale Scale) and differences in social activity (Frenchay Activities Index) and generic health status (SF-36). Health service and social service cost per patient were compared for the two groups.

RESULTS

180 patients were eligible and 140 (78%) were randomized. The groups were well balanced for age, sex, social class and initial Barthel index. We achieved follow-up in 88% of subjects who were alive at 6 months. We detected no significant differences in patient outcomes, although there was a non-significant improvement in measures of physical function and social activity in the domiciliary group. Domiciliary patients had more physiotherapy time per session and more district nurse time, and made greater use of social service day centres and home helps. Total cost per patient did not differ significantly between the two groups, with reduced health service costs in the domiciliary arm offset by higher social service costs.

CONCLUSION

No significant differences were detected in the effectiveness of the two services. Neither service influenced patients' mental state, and their social activity remained low. Total costs were similar. A mixed model of day-hospital and domiciliary care may be most cost-effective for community stroke rehabilitation, but this requires further evaluation.