Patient Reported Outcome Measures

Patient reported outcomes are a key measure of whether patients’ health has improved following specific interventions.  

Different metrics are available for NHS-funded and privately funded activity, and privately-funded cohorts tend to present earlier, so the scope for potential health gain is different to NHS patients. Nevertheless, we can see useful information from the range of metrics available. 

NHS England publishes PROMs data for patients undergoing orthopaedic procedures. Looking at the most recently published information for primary hip and knee replacements for NHS patients⁵, we see:  

• 129 independent hospitals reported PROMs data, of which 60 reported sufficient information to calculate adjusted health gain information. 

• Despite making up under 40% of the hospitals with available adjusted health gain information, independent providers are disproportionately represented among those hospitals where patients report the largest health gain. The EQ-5D Index shows 6 of the top 10 for hip replacements and half of the top 10 for knee replacements are independent providers 

• 90% of NHS patients undergoing a primary hip replacement and 80% of patients with a primary knee replacement at an independent provider report a health gain as measured by EQ-5D. The proportion showing a health gain when measured by the Oxford scores are even higher. These figures are similar to those reported at NHS organisations 

The plot below shows the average adjusted health gain for the top 20 providers for primary hip and knee replacements for NHS patients: 

We also have an insight into the reported outcomes of privately-funded patients through information published by PHIN, which covers a wider range of procedures than is available for NHS patients, including: 

• Primary hip replacements  

• Primary knee replacements 

• Cataracts 

• Cosmetic surgery 

In the latest data, only three NHS private patient units had submitted sufficient information to calculate improvement rates, so clearly comparisons between sectors are inappropriate. Also, as previously noted, privately-funded and NHS-funded cohorts typically differ so it is not possible to compare the two.  

Despite these caveats, we see that the percentages of patients reporting their conditions improved after private surgery were: 

• 98% for hip replacements 

• 93% for knee replacements, and 

• 84% for cataract surgery 

Cosmetic surgery. PHIN also reports data relating to three cosmetic surgery procedures. Data completion rates are steadily improving but are considerably lower than for the joint replacements and cataracts, which in part is because these are newer collections. The percentages of patients reporting improvement after their procedures are: 

• 99% for augmentation mammoplasty 

• 93% for liposuction 
  
  
• 97% for rhinoplasty