Assessing equity of use and outcome of hip replacement surgery using PROMs data. Jenny Neuburger, King s Fund Conference 22 nd November 2012

Size: px

Start display at page:

Download "Assessing equity of use and outcome of hip replacement surgery using PROMs data. Jenny Neuburger, King s Fund Conference 22 nd November 2012"

Cynthia Wilcox
8 years ago
Views:

1 Assessing equity of use and outcome of hip replacement surgery using PROMs data Jenny Neuburger, King s Fund Conference 22 nd November 2012

2 Structure of talk 1. Patient pathway points at which in differences in use of health services occur 2. PROMs to assess differences in use and outcome 3. Evidence of differences in use 4. Evidence of differences in outcome 5. Summary 6. Challenges in using patient-reported data

3 Presents to GP with hip pain Not referred Treatment & referral if criteria met Patient pathway for elective hip replacement Help-seeking behaviour, other illnesses, GP referral criteria Assessment by surgeon v Preop assessment Hip replacement Postop rehab Does not meet criteria Not fit for surgery Surgical performance, discharge planning, rehabilitation, social support, patient expectations Fitness for surgery, ability to benefit from surgery, patient preferences

4 Measures used to assess equity Evidence of differences in use: Preoperative Oxford Hip Score (OHS) Duration of hip problems Differences in outcome (partly related to use): Postoperative OHS Differences in postoperative improvement: Postoperative OHS adjusted for preop. OHS Single transitional item ( How are the problems now in the hip..., compared with before the operation? )

5 Differences in use by socioeconomic status Index of Multiple Deprivation: Preoperative Oxford Hip Score Mean difference¹ Longstanding problems (> 5 yrs) % odds ratios¹ 1 (least deprived) 19.2 Reference 16.8% Reference (=1) * 18.2% 1.08* * 19.1% 1.12* * 19.7% 1.11* 5 (most deprived) * 21.0% 1.11* 1 Adjustment made for sex, ethnicity, age group and comorbidities * Differences are statistically significant at 5% level Source: Neuburger J, Hutchings A, Allwood D, Black N, van der Meulen JH

6 Differences in use by ethnicity Ethnicity: Preoperative Oxford Hip Score Mean difference¹ Longstanding problems (> 5 yrs) % odds ratios¹ White & White British 17.6 Reference 18.5% Reference (=1) Mixed ethnicity % 1.22 Other ethnicity % 1.58* Black & Black British % 1.40* Asian & Asian British * 23.3% Adjustment made for sex, ethnicity, age group and comorbidities Differences are statistically significant at 5% level

7 Differences in outcome by socioeconomic status Index of Multiple Deprivation: Postoperative Oxford Hip Score Mean difference in outcome¹ measure of improvement ² Reported no improvement % OR² 1 (least deprived) 39.4 Reference Reference 5.0% Reference * % * -0.7* 5.9% 1.2* * -1.4* 6.2% 1.3* 5 (most deprived) * -2.8* 8.2% 1.7* 1 Adjustment made for sex, ethnicity, age group, general health, primary or revision surgery, diagnosis of osteoarthritis, comorbidities and hospital 2 Adjustment made in addition for preoperative OHS and presence of longstanding problems Source: Neuburger J, Hutchings A, Black N, van der Meulen JH

8 Differences in outcome by ethnicity Index of Multiple Deprivation: Postoperative Oxford Hip Score Mean difference in outcome¹ measure of improvement ² Reported no improvement % OR² White & White British 37.7 Reference Reference 6.0% Reference Mixed ethnicity * % 0.0 Other ethnicity * -2.5* 8.4% 1.4* Black & Black British * -3.7* 7.2% 0.9 Asian & Asian British * -4.8* 8.8% Adjustment made for sex, ethnicity, age group, general health, primary or revision surgery, diagnosis of osteoarthritis, comorbidities and hospital 2 Adjustment made in addition for preoperative OHS and presence of longstanding problems

9 Summary People living in more deprived areas and of Asian ethnicity have: more severe hip problems by the time they have surgery than other groups; less good outcomes from surgery, partly related to worse preoperative severity; and less postoperative improvement in their condition.

10 Challenges in using PROMs 1. Differences in self-reporting by socioeconomic status & ethnicity (perception, expectations, knowledge of symptoms & healthcare system) 2. Assessment of equity may depend on choice of measure (eg, condition-specific PROMs vs. subjective evaluation) 3. Interpreting magnitude of differences, assessing clinical & practical importance

Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery

Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery Andrew Hutchings, Mira Varagunam, Nick Black Department of Health Services Research &