Hip replacement at your local Hospital
In Part I we looked at how to answer the question: How good is your local hospital? Take a look back at that article here if you missed it.
In short, Patient Reported Outcome Measures (or PROMs) measure what matters to patients after an operation or medical treatment. For example, for hip and knee replacement the Oxford hip or knee score measures pain and function by asking 12 questions each scored from 0 to 4 to give a total out of 48 points; 0 is really bad and 48 is good pain and function.
Hospitals performing hip or knee replacement take part in the National PROMs Programme and collect these Oxford scores before and six months after surgery. The scores are then collected together for all patients and the health score gain for a particular hospital or group of patients made available online. So patients considering hip or knee replacement can judge how good their local hospital or a particular surgeon will be for them.
It’s early days and the information is currently hidden away and not readily available; but we can check out how well the Duchy hospital performs for hip replacement in Figure 1 (see below)
Figure 1: Oxford hip scores for Duchy Hospital
Last year, for 2015-16, 231 patients operated at the Duchy Hospital improved their Oxford pain and function score by nearly 23 points following hip replacement. The average score gain across the country was around 21 point. So the Duchy scores significantly better than average, by about two points. Now this might not sound a lot, but those two points overall could be the difference between ‘mild’ and ‘moderate’ pain or the ability to walk ’30 minutes or more’ against ‘5 to 15 minutes’; an important difference and I know what result most people would rather have.
You’ll also notice that the results for the Duchy Hospital are highlighted bright blue and labeled ‘Outlier’ and ‘Positive (95%)’; what does this mean?
Well, a 95% outlier is a statistical term that puts the Duchy Hospital outside the results of 95% of hospitals in the country. And outliers can either be positive or negative; so the Duchy Hospital, as a ‘Positive Outlier’ achieves results for hip replacement that are among the top 2.5% of hospitals. Pretty good really.
Through the NHS Choose and Book system patients have more choice than ever before about where they’re treated. So armed with information about which hospitals achieve the best improvements in pain and function patients and their families can make sure that their local hospital is likely to do a good job for them. We’ll check out some of the things to watch out for when looking at PROMs and check out some results for knee replacement in Part III.
Dan H Williams MSc FRCS
Consultant Orthopaedic Surgeon