Photographer:Fotograaf: Klaus Tummers
Anyone who has recently visited a hospital, his or her GP, or a physiotherapist will be familiar with it: the request to fill out a questionnaire. “It is a trend in health care, the patient-reported outcome measure, to the extent that it has even become a noun, the PROM,” says Sandra Beurskens, professor of Goal-Oriented Measurement in Patient Care and reader at Zuyd Hogeschool.
The objective is to discover how patients experienced their treatment. “Take a knee operation. Doctors used to say: the new knee is in place, so the operation was successful. Now they are also looking at the experienced effect on the patient's performance. What could he not do beforehand and can do so now? Maybe the operation was indeed a success, but that person still has a lot of pain and trouble walking. Surgery is not always the best solution. It also depends on what the patient still wants to be able to do. These types of results help other patients decide whether or not to have the operation.”
The problem with this development is that there are a lot of questionnaires and one doesn't always know which questionnaire is suitable for which purpose. “There are hundreds of these types of so-called ‘PROM’ lists. People see that a list is ‘valid’ and assume that it is good. They think that validity is a static concept, but the definition is that you measure what you want to know in the proper context. The last element is very important, without that, the list is not valid. You need to think about this carefully beforehand: why do you want to measure something, what is it exactly that you want to measure, what are you going to do with the results, and how can these help you improve the quality of care?”
As project leader of Limburg Meet (LIME) - a Brightlands innovation programme by Zuyd Hogeschool, the UM and the Province of Limburg that aims to measure more cleverly and collect data more efficiently in order to provide better care - Beurskens came across examples where things went wrong. “The questions may be far too general. It looks as if the list can be used widely, but with some conditions you want to know if the patient is experiencing specific complaints. Take for example the patient with knee complaints; in that case, you not only want to know if they feel fitter in general, but in particular if they have trouble bending and walking up and down the stairs.”
Another mistake that is often made, is a questionnaire that has been developed for scientific research ending up in a GP practice. “It is often too complicated and too long for that purpose. You always need to know your target group well when you formulate the questions. For people with aphasia or a mental disability it may be more useful to work with pictograms or pictures.”
A lot of time goes into handing out, completing and processing questionnaires, both for patients and for the professionals. “So it is a great nuisance if no useful information can be derived from them.” How can this be prevented? “Always remain critical, read through the questions thoroughly. If they are not clear to you and your colleagues, then they will most likely not be clear to patients either. In that case, you shouldn't use them. If necessary bring in an expert. Measuring is really a discipline in itself, there is a whole world behind it.
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