Patient Reported Outcome Measures PROMS Workshop Development 2013/14

Transcription

1 Patient Reported Outcome Measures PROMS Workshop Development 2013/14 Liz Vernon-Wilson, Christie Garner Clinical outcomes, Clustering and PROM webpages available at 1

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3 Contents page What are Patient Reported Outcome Measures Page 4 & 5 Why Bother With PROMs Page 6 What PROMs have shown so far Page 7 How are we going to measure PROMs Page 8 Why Hope, Agency and Opportunity Page 9 More information on Hope, Agency and Opportunity Page 10 What does this mean for the service user Page 11 Role play Page 12 Role play cont d Part 1 and 2 Page 13 Role play cont d Part 3 Guidelines Page 14 Role play cont d Part 3 The Care Plan Page 15 Role play cont d Part 4 Group Evaluation Page 16 Collecting and recording H, A, O Page 17 Overview Page 18 Contact details Page 19 3

4 What are Patient Reported Outcome Measures? In November 2011 the Department of Health published a report setting out a number of quality indicators that should be used to measure the service provide by Mental Health Trusts. Patient Reported Outcome Measure is a quality indicator mandated under Action 7: Implementing Quality and Outcome Measures of the Department of Health's Payment by Results programme (PbR). Commissioners expect services to offer Patient Reported Outcome Measures (PROMs) as a part of routine clinical practice. The primary use for PROMs is to form a clinical discussion about the patient s progress and to influence the care plan management. The secondary use is to provide information on how patients see their outcomes for groups of service users, to support service improvement and accountability to the commissioner. 4

5 Patient Reported Outcome Measures (PROMs) Hope, Agency and Opportunity Better outcome for service users Commissioners CQUIN PbR Primary use: To form a discussion about mental health and recovery as part of routine clinical practice. To influence and inform a care plan. Secondary use: To provide information on how service users see their outcomes To support service improvement and accountability to the commissioner. 5

6 Why Bother with PROMs? Exploring Your service users Views A central tenet of NHS* policing is focusing on service users experience (quality) and shared decision making. i.e. No decision about me, without me should be the norm. Research shows that shared decision making can help promote better mental health care as it impacts on quality of life, autonomy, choice and health outcomes. Using PROMs can help engage service users with the treatment and care they receive, and support them to work towards personalised goals. PROMs can facilitate service user s involvement in decision making and in care planning. It can promote partnership between professional and patient, and help us orientate practice towards recovery. * Liberating the NHS, DoH

7 What PROMs have shown so far PROMs guides a recovery focused conversation and provides a holistic picture of need. Hope, Agency & Opportunity has been welcomed as a useful tool to help service user s engage and inform their care plan and CPA review. Scores on PROMs show a positive change over time; there is an improvement in how people feel about their hope, agency, opportunity and working relationships from initial appointment to discharge. There is a relationship between PROM results and current clinical measures. For example data shows a trend between increased mood scores on HoNOS and service users rating themselves as having less hope, agency and opportunity. 7

8 How are we going to measure Patient Reported Outcomes? Hope, Agency and Opportunity is a questionnaire developed by service users and mental health professionals at the Southern Health Recovery College. Your peers have chosen this questionnaire to measure Patient Reported Outcomes. The Hope, Agency and Opportunity questionnaire has just four questions that asks service users how much hope, agency (or control) and opportunity they feel, and if staff are supporting them with recovery. Information collected from Hope, Agency and Opportunity will measure a service user s progress on their journey of recovery. Hope, Agency and Opportunity will also help us to understand whether we are developing recovery orientated services. 8

9 Why Hope, Agency and Opportunity? These concepts consistently appear within research literature as an essential part of recovery: o o o Hope making recovery a reality. Hope is about establishing and supporting expectations of an individually fulfilled life and sustaining motivation. Agency taking control of your wellness. Concerned with developing self-determination, self-management, choice and responsibility, agency relates to gaining a sense of control over illness. Opportunity for yourself and getting involved. Opportunity links recovery to social inclusion, participation in a wider society and being a valued member of it. Research suggests that these three elements are meaningful to service users and facilitate personal recovery. Hope, Agency and Opportunity can be used to engage with service users in a discussion about their wellbeing. It can help you to understand what recovery means to service users and it will inform the care planning process. 9

10 For More Information on Hope, Agency, Opportunity and Recovery very_a_reality_policy_paper.pdf Julie, R., & Perkins, R. (2003). Social Inclusion and Recovery: A Model for Mental Health Practice: Baillière Tindall. l%20_final%20(2).pdf 10

11 What does this mean for the service user? The Hope, Agency and Opportunity questionnaire is a means of asking service users for their views on things that are important to their recovery. By talking to service users about hope, agency and opportunity, we can encourage recovery-oriented care, and focus on their individual needs. It can help you to understand what recovery means to the service user and how you can support them towards recovery. The concepts of Hope, Agency and Opportunity can be use to build a care plan, that has service user involvement. The Hope, Agency and Opportunity questionnaire is something that the service user owns and take away when they leave the service. 11

12 Role Play Exercise: Use Hope, Agency and Opportunity to guide a conversation. Part 1: Form groups of 2 or 3. One person is the service user, one person is the care coordinator/ lead professional, (one person is the observer). Part 2: Change roles. This time the person in the role of service user might be harder to engage As the care coordinator/ lead professional how do you introduce the Hope, Agency and Opportunity questionnaire and discuss the answers given by the service user? Part 3: Write a care plan with the service user that is based on the conversation in part 2. Part 4: In larger groups (between 4-6) discuss how you encouraged the service user to talk about the answers they gave on the H, A, O questionnaire i.e. What language, phrases or prompts did you use? 12

13 Role play exercise cont d... Part 1 & 2: Guidelines How do I support the service user to answer the H, A, O questions? If the service user has not completed their H, A, O questionnaire at the time of your visit, ask them to complete one before you begin. The service user should complete the H, A, O questionnaire independently. This is their perception of these questions. However if the service user finds it difficult to answer any of the four questions then these examples might help (more on page 14): o o o o Hope: What is important in your life? Is there a goal you would like to work towards? Agency: How much control do you feel you have? Have you been given enough choice over the support you receive? Opportunity: What opportunities would you like to have? How can we support you to build on your strengths, and do things that are important to you? Working relationships: I can support you with..., Together we can work on What has helped you before? What is not helpful? The service user can decline to answer any of the four questions, just record this in the Further details section. Perhaps come back to it at a time when they feel more comfortable answering these questions. When the service user has completed the H, A, O questionnaire take a copy for your records and where possible leave the service user with the original copy. Answers from the questionnaire can be the basis of a conversation that informs a care plan and ensures the service user is always involved. 13

14 Role play exercise cont d... Part 3: Guidelines How do I expand on the H, A, O concepts to inform a care plan? When the service user has independently completed the H, A, O questionnaire, you can discuss their answers with them to inform their care plan. Below are some questions to help you to expand on the H, A, O concepts. These are just guidelines that you could use to start a recovery focused conversation. Alternatively, you could use the service user prompts on the H, A, O questionnaire. Hope Agency What is important to you? How much choice have you received What gets you up in the morning? about your care? What are your strengths? Do you feel listened to? When you are feeling well, what do you enjoy doing? Have you been able to discuss your concerns about your care? Do you have a goal you would like to Do you feel you have control? work towards, and can you describe it How much information have you to me? received? Do you believe things will get better? What information would you like to have What does being well look like to you? to help you understand and manage your mental health? Can we discuss how I can help you? Do you have the right information, to I believe in you. help you understand and manage your I will hold the hope for you. wellbeing? If I could wave a magic wand Do you have a WRAP? Opportunity What opportunities to you feel would help you? Are there meaningful things to do in your life? Are you able to take steps towards your goals? Have you been given the opportunity to go back to work, study or volunteer etc.? What would improve your quality of life? Are there opportunities to get involved in your local community? What have you tried before? Working Relationships How can we get this right for you? What things can I do, that bring out the best in you? What has worked before? What hasn t helped? Do you feel listened to by staff? Do you feel staff are helping you to achieve your goals and aspirations? I can help you best when It helps me if you can Can we agree where we are going to meet? 14 14

15 Role play exercise cont d... Part 3: Care Plan use Hope, Agency and Opportunity to inform a care plan. Key points highlighted in the discussion? Goals: Interventions What will the service user do: What will the care coordinator/ lead professional do: Evaluation: 15

16 Role play exercise cont d... Part 4: Group discussion and evaluation What language, phrases or prompts did you use to help build on the H, A, O questions? How did you use H, A, O to inform a care plan with the service user? What could you improve for future use? Any comments 16

17 Collecting and Recording H, A, O Hope, Agency and Opportunity will be offered to service users at: 1. Initial appointment/assessment. 2. CPA review/care plan review 3. Discharge The practitioner should discuss the answers given on H, A, O with the service user. This will be used to inform a care plan that the service user is fully involved in. Download HAO care plan templates: OR RiO HAO care plan in the care plan library. Add PROM HAO offered in progress notes. To keep track of when you have offered PROMS use the filter by text option and search PROM. Tear off the Further Details page, give this to your admin team. They will input this data on to sharepoint. The service user must keep the original copy. The Outcomes/Health Technology team will analyse this data and report back findings to your team and commissioners. 17

18 Overview: Hope, Agency and Opportunity A Patient Reported Outcome Measure is a quality indicator, which will support service improvement and helps accountability to the commissioner. The Hope, Agency and Opportunity questionnaire captures the service users opinion on issues important to their recovery. It can help to engage service users in their care and make shared decisions about a care plan that is led by service users. The H, A, O questionnaire will be offered to service users at initial appointment, CPA/care plan review and discharge. The answers from the H, A, O questionnaire will be used and contextualised with clinician rated outcomes and patient experience measures to support the development of recovery focussed services. 18

19 Thank You for Taking Part We want to know your opinions on H, A, O and the feedback you receive from service users. Implementing PROMs is in the developmental stages, so you have the opportunity to influence how H, A, O is used in your service for the people you support. If you have any questions or suggestions please speak to your Team Manager/Leader or Christie.garner@southernhealth.nhs.uk Elizabeth.vernon-wilson@southernhealth.nhs.uk 19