I attended the inaugural Patient Reported Outcomes Measures (PROMs) Conference in Sheffield on Thursday 9 June 2016. Supported by four NIHR CLAHRCs across England, it offered an opportunity for those who work with PROMs to present to over 100 people interested in related areas of research. Typically, I tend to focus conference attendance on my specific research interests; there is an opportunity cost to what else you could be doing with your time after all. But the very reasonably priced conference fee (£30) on top of having a poster presentation accepted on some PROMs related postdoc work I have been doing meant I was willing to take a step into slightly unchartered waters.
I was safe in the knowledge that I knew I would be interested in one of the plenary talks on measuring wellbeing, presented by Sheffield’s own John Brazier and discussed commendably by Exeter’s Colin Green. Although talk of a well-being adjusted life year or WELBY as a QALY type outcome was briefly discussed, the conversation has not changed dramatically since I first heard of the idea in 2013, expect then it was known as a WALY. Indeed, one of Colin’s key arguments was whether reinventing the wheel in the QALY model is something that should be pursued by health economists if attention is shifted towards wellbeing, given the notable qualms health economists have with the existing state of affairs.
But there were a number of other relevant contributions made by health economists too. Koonal Shah, a PhD student at Sheffield and a researcher at the OHE, proposed an alternative to the time trade off approach called personal utility functions, in an attempt to move away from the hypothetical, and in many cases, unrealistic health states presented to individuals in preference elicitation exercises. Researchers from the University of York presented on whether choice of hospital for surgery is influenced by previous evidence of PROM quality outcomes (Giuseppe Moscelli) and how expected change in health utility on the EQ-5D from joint surgery can be meaningfully presented to patients prior to having interventions on the likely outcomes for them (Nils Gutacker). Ines Rombach, a PhD student at HERC Oxford, presented on some of the challenges of multiple imputation of PROMs at item, subscale and overall score level, while Jeshika Singh, a PhD student and researcher at HERG Brunel, presented a study looking into how well the EQ-5D, GHQ and WEBWMS explained social care needs based on data from the Health Survey of England.
However, it was something a bit different in the end that caught my attention the most. Joanne Greenhalgh, an Associate Professor at Leeds, succinctly presented what looked like a very lengthy piece of research, using realist synthesis to examine how PROMs could lead to improved patient care in practice. Some of the insights from the study included that a PROM orientated focus could lead to tunnel vision, meaning other non-reported aspects of care suffer, and that PROMs could lead to a suspicion of gaming the system. Other key discussion points for health economists included the phrasing of the EQ-5D as a measure of health status or health related quality of life and whether health economists actually work with PROMs at all, once health economists have attached general population values to them.
There were clearly jitters in the PROMs community given the uncertainty over the continuation of the NHS PROMs programme that started to routinely collect data from patients for four types of surgical intervention in 2009. Perhaps there was also frustration among the PROMs being foisted upon some researchers, a theme not completely unheard of in the health economics community either. Nonetheless, as a first attempt at organising such an event, the PROMs conference team should be reasonably happy with the event in itself and it certainly has the potential to become a regular feature in the UK conference circuit.