Dr VALDERAS: When what you have are patient health outcomes: a utopia essay?

1 04 2013


Jose M Valderas

Director of the research group in services and health policy in the Department of primary care at the University of Oxford.



The British national health service (National Health Service (NHS)) It is engaged in a unique initiative in the world in the field of patient-reported outcomes (patient reported outcomes) known as the PROMS programme (by patient Reported Outcome Measures). For the first time, the usual rhetoric about the importance of these measures has given way to an ambitious project whose long-term vision is that extend their use to all areas of health care where feasible.

From 2009, collected measurements of reported outcomes for all patients and four elective surgical procedures funded by the NHS, whether they are carried out in public hospitals and private. Is currently in pilot testing phase expansion to coronary revascularization procedures, cancer, chronic disease in primary care and dementia. The United Kingdom is placed in this way once more as spearhead and authentic ideas in health services research laboratory, nearly a decade after the implementation of the primary care incentive system known as the Quality and Outcomes Framework.


Following in the footsteps of the previous programme, one of the key features of the PROMS initiative lies in the objectives are focused on the use of information to encourage the improvement of the quality of care as a whole. It relies therefore on aggregate information (by professional, Center and sanitary areas), But even if you are exploring applications of such information as support to areas as diverse as health technology assessment and the preparation of contracts between the primary care groups and providers of health services of second level, There currently is no plan to advance the clinical use of information. And yet this is a limitation that necessarily has to be seen by initiative of the own professional, to overcome the gap between an assessment by indicators and a clinical practice in which this information is absent.


In these matters the implementation is absolutely essential and in a few years we will know if it has been known to extract the maximum fruits to this opportunity and prepares the ground for its application to other areas and countries, or if on the contrary the harsh reality of the resistance to change is imposed again in clinical practice based on the poor implementation of the best ideas.




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