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Improving patient reported outcome measures for use in primary care

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The NHS Outcomes Framework sets out a vision of a performance model based on health outcomes, rather than processes of care. This vision includes strategies to improve quality of life (QoL) for patients with long-term conditions and enhance their satisfaction with care. The framework suggests these goals may be met, in part, by increased utilisation of patient reported outcome measure (PROMs) to monitor changes in patient quality of life and care experience. Completing PRO Ms increases patient involvement in care and help identify specific areas amenable to additional care (e.g. psychological issues). Despite demonstrable benefits of routine screening, questionnaire administration is frequently dismissed in primary care due to the competing demands of short consultation times and lengthy questionnaires. Previous research using the Rasch measurement model to assess the psychometric properties of commonly-used patient-reported outcomes has highlighted a number of issues. These issues include item redundancy, differential item functioning and disordered category thresholds. Such measurement inaccuracies can have serious implications for clinical decision making and research. Implementation and measurement accuracy may be improved by the combined use of computer adaptive testing (CAT) and Rasch analysis. Electronic questionnaire administration using CAT may increase measurement accuracy and reduce response time by selectively presenting questions based on past responses, disease group or demographic information. Scores from CATs are instantly calculated and presented in a manner that is easily interpretable by clinicians and patients. We conclude that the vision of improved monitoring for patient quality of life and care experience may be realised by adapting existing pencil-and-paper questionnaires for CAT administration in primary care.

This talk is part of the Cambridge Psychometrics Centre Seminars series.

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