1. 1 Patient Outcomes & Experience Measurement in Podiatry Results from two NHS departments

2. Clinician “I see your ulcer is healing nicely” Commissioner “prove these treatments actually do any good” 2 CoMetrica © 2010 Outcomes are easy to see - aren’t they? Patient thinks “maybe but I still can’t get to the shops” Carer/relative thinks “is this the best treatment available?”

3.  of everyone  not a skewed sample  accurately  the right measures at the right time  quantitatively  recognised, benchmarked  qualitatively  fast direct feedback to the department  continuously  not an annual survey – “ticking the box” 3 CoMetrica © 2010 So how can you measure Outcomes & Experience?

4. 4 CoMetrica © 2010 Choose your census points along the patient pathway Referral1st visit After visit After treatment Short-term follow-up 6- 12 weeks Long-term follow-up 6 months+ Key: Clinical Outcomes Patient Experience Generic PROM Specific PROM Pre - Tx Communication Organisation information Generic PROM Specific PROM Accessibility Cleanliness Facilities 1 st impressions Pain Pain management Privacy &Dignity Competency Information Generic PROM Specific PROM Post - Tx Generic PROM Specific PROM Long Term f/up Communication You don’t have to see the patient again to follow them up longer term

5.  standard PROMS and local measures  clinical AND experience  multiple question types:  multiple choice  image drawing  free text return  image recognition  Visual Analogue Scales  different questions for each patient group & pathway stage 5 CoMetrica © 2010 Example measures available

6.  clinical images e.g. What do your feet look most like?  comparative data  follow-up  use any images 6 CoMetrica © 2009 Image based questions

7.  Pilot scope  500 patients in summer 2010  Measures: generic health foot health patient experience  + continuous daily feedback from patients  Responses  276 returned, 54% response rate 3% on-line 97% on paper  50% of responses back within 1 week of dispatch  results updated daily  volumes provided statistically significant results 7 CoMetrica © 2010 South Birmingham Podiatry Service Mandy Cadge – Podiatry Services Manager

8. 8 CoMetrica © 2010 Overall results Scale At treatment start After 60 days Discharged Responses n 127 (51%)121 (50%)23 (50%) Average results Generic health PROM – EQ5D 0= feel like “death” 1= perfect health 0.550.630.56 Foot health PROM - FHS 0= maximum pain, mobility restriction 1=no pain, concern, restriction 0.520.570.59 Experience: Communication 0% = “poorest” 100% = “best possible” 90% Experience: Clinical environment, access, facilities 0% = “poorest” 100% = “best possible” 86% Experience: Clinical competency 0% = “poorest” 100% = “best possible” 88% Experience: Overall satisfaction 0% = “poorest” 100% = “best possible” 95%87%85%

9. 9 CoMetrica © 2010 Foot Health Score Gain reduces with age Patient groups likely to be more significant than age Low volume bands excluded

10. 10 CoMetrica © 2010 Patient Experience High scores generally Recall of being provided with information lowest Further breakdown by location, staff etc. valuable

11.  Project scope  ALL patients going through prevention team  1000 patients over 5 weeks in Sept/Oct 2010  Measures: generic health foot health patient experience Health advice reception & impact  + continuous daily feedback from patients  Responses  560 returned, 56% response rate 2% on-line 98% on paper  Consistent response rate across service 11 CoMetrica © 2010 Solent Healthcare (Portsmouth) Podiatry Mathew King – Project lead

12. 12 CoMetrica © 2010 Overall results Scale At treatment startAfter 90 days Responses n 178189 Average results Generic health PROM – EQ5D 5 0= feel like “death” 1= perfect health 0.500.57 Foot health PROM - FHS 0= maximum pain, mobility restriction 1=no pain, concern, restriction 0.510.58 Clinical Competency perceived 0% = “poorest” 100% = “best possible” 84% Experience: Overall satisfaction 0% = “poorest” 100% = “best possible” 91%93% Health Advice (only for relevant patients) MotivationalMade a difference Diabetes Explanations understood of impact & specific care advice given 79% Smoking 53%50% Weight Management 68%0%

13. 13 CoMetrica © 2010 Foot Health Score 2 Marked improvement in all areas

14. 14 CoMetrica © 2010 Detailed reports Demonstrating reduction in pain frequency as a result of treatment

15. 15 CoMetrica © 2010 Foot Health Score 2 Change in foot health by department’s own severity/ treatment classification

16. 16 CoMetrica © 2010 Patient Experience Can review by: Location Staff Pt Age Category Treatment Clinic A Clinic B Clinic C Clinic D Clinic EClinic F Clinic G Clinic H

17. 17 CoMetrica © 2010  Highly visible patient engagement, inclusive reach  No front line effort, standard reports save time  Continuous results linked to patient data  Operational qualitative tool – daily feedback  PROMS & benchmarks are powerful commissioning levers  Differential value by patient groupings evident- prioritisation? Conclusion

18. 18 CoMetrica © 2010 Thank you Stuart.Mathieson@CoMetrica.co.uk 07973 212306