The role of the patient in evaluating quality of care
Author(s)
Caris, Jochem
Type
Thesis
Abstract
This thesis outlines the emerging role of the patient, central in the transition from a volume-driven towards a patient-driven healthcare. Healthcare systems, regardless of region or economic status, must develop new ways to deliver care whilst at the same time improving both quality of care and containing costs. Today’s society is increasingly ‘horizontal’ shaped by affiliations and networks, and this changes the way information flows, increasing people’s willingness to participate in the decision- making process. Encouraging more patient involvement by promoting feedback will increase communication between system and users, this is important as it can improve quality of service. The inception and preliminary results of a national programme based around patient-reported health surveys, i.e. PROMs, are discussed together with the potential of the programme and its limited evidence on how this translates to quality of care for patients.
The feasibility of PROMs data, in order to investigate important difference as reported by patients in this large national cohort, is tested by segmentation into individual procedures. A subsequent risk analysis of important confounders demonstrates that poor mobility and self-reported depression are significant predictors of poor HRQoL outcomes as well as self-reported adverse events. A further comparison between self-reported and administrative collected comorbidities is undertaken to substantiate the reliability of self-reported comorbidities followed by the development of an accumulated risk prediction score generated from self- reported comorbidities to identify individual patient segments before treatment. And finally, a mixed method study is undertaken into factors behind poor unit response rates by exploring the patients’ views on PROMs and their place in quality of care.
This thesis demonstrates the limitations of the current data dissemination of national PROMs data and proposes several steps of improvement to increase relevance to both patients and clinicians.
The feasibility of PROMs data, in order to investigate important difference as reported by patients in this large national cohort, is tested by segmentation into individual procedures. A subsequent risk analysis of important confounders demonstrates that poor mobility and self-reported depression are significant predictors of poor HRQoL outcomes as well as self-reported adverse events. A further comparison between self-reported and administrative collected comorbidities is undertaken to substantiate the reliability of self-reported comorbidities followed by the development of an accumulated risk prediction score generated from self- reported comorbidities to identify individual patient segments before treatment. And finally, a mixed method study is undertaken into factors behind poor unit response rates by exploring the patients’ views on PROMs and their place in quality of care.
This thesis demonstrates the limitations of the current data dissemination of national PROMs data and proposes several steps of improvement to increase relevance to both patients and clinicians.
Version
Open Access
Date Issued
2015-09
Date Awarded
2016-08
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Darzi, Ara
Smith, Pete
Mayer, Erik
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)