Background There is considerable variation at a country level in the use of health outcome measures to support clinical governance.In 2009 the NHS in England introduced Patient-Reported Outcome Measures (PROMs) as a national performance indicator for four common elective procedures (hernia repair, varicose veins, and hip/knee replacement). Outcome data is compared at a Trust level and reported publically to promote quality improvements. No such outcome monitoring has been introduced in a neighbouring jurisdiction, the Republic of Ireland. As the Republic of Ireland has a very similar profile of patients and surgeons to those seen in the NHS, it is an ideal comparison for evaluating the impact of the English PROMs Programme. In this study we compare the results of patients undergoing hip replacements in Ireland and England.
Methods Patients undergoing hip replacement surgery were recruited from 16 hospitals in Ireland, under the care of 35 surgeons between April 2011and November 2012. Mirroring the methodology used by the English PROMs Programme, patients were asked to complete a questionnaire which included the Oxford Hip Score (OHS) before and six months after their operation. To enable a comparison with data from the English PROMs programme, the Health and Social Care Information Centre in England provided the OHS mean change score for patients undergoing primary surgery between April 2010 and May 2011.
Results A mean change score of 20.2 points on the OHS (95% CI 20.1, 20.3) was recorded for the 29,544 patients undergoing primary hip replacement surgery who reported data to the English PROMs Programme. This compares to 20.7 (19.9, 21.4) for the 795 Irish patients. This indicates no statistically significant difference between patient-reported outcomes in the two jurisdictions.
Conclusion This study presents a unique opportunity to assess patient outcomes across health systems with different forms of clinical governance. Our study demonstrates no differences in patient outcomes between a country which benchmarks and publically releases performance data and one which does not. In defence of the English PROMs programme it may be too early to evaluate effectiveness as quality improvements may only be evident when PROMs become influential to the decision making of providers and purchasers. Nevertheless, because our understanding of the value of outcome data in clinical governance is in its infancy, cross country comparisons are useful in the absence of better evidence.
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