Patient Reported Outcome Measures (PROMS), Pre and Post Operative Data, April 2009 to October 2010, West Midlands Introduction Patient Reported Outcome Measures (PROMs) measure quality from the patient perspective. Initially the PROMs programmes cover four clinical procedures: groin hernia surgery, hip replacement, knee replacement and varicose vein surgery. PROMs calculate the health gain (as reported by the patient) after surgical treatment using pre and post operative surveys. This report updates PROMs data to October 2010 for all West Midlands’ providers. At this time the data remains experimental nationally, therefore this report does not draw any conclusions on the variation in the quality of services. The aim of the report is to keep clinicians and commissioners informed about the programme and to seek their views on the process and how WMQI can assist in the application of PROMs in improving the quality of services. Previous PROMs reports by the WMQI can be accessed from: http://www.wmqi.westmidlands.nhs.uk/clinical-measures/proms/wmqis-work-on-proms/
Data Collection Before a patient undergoes one of the four PROMs procedures, the provider should offer the patient a PROMs questionnaire (i.e. pre-operative questionnaire) for completion. The guidance states that this should happen in the interval between the patient being passed fit for surgery and the treatment taking place. Completion of the questionnaire is voluntary for the patient. The completed pre-operative PROMs questionnaires are then transferred to the DH contractor responsible for collating the information, where the questionnaires are linked securely to the Hospital Episode Statistics (HES)1 and National Joint Registry (NJR)2 databases. After three or six months, depending on procedure, the DH contractor posts out the follow-up postoperative questionnaire to the patient’s home. Once the form has been completed by the patient and returned, it is electronically scanned and linked with the pre-operative data along with HES and NJR, if applicable.
Definition of PROMs Measures Two types of PROMs measures are reported: (i) the EQ-5D system for general health and (ii) the condition-specific measures, Oxford hip and knee score and Aberdeen varicose vein score.
1 2
See http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937 for details of HES. See http://www.njrcentre.org.uk/njrcentre/default.aspx for details of NJR.
1
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
EQ-5D Index Score The EQ-5D descriptive system comprises the following five dimensions describing the patient’s general health: mobility self-care usual activities pain/discomfort anxiety/depression Each dimension has three levels: no problems, some problems, and severe problems. EQ-5D health states are then converted into a single summary index score up to 1(best health) by applying a formula that essentially attaches weights to each of the levels in each dimension. Oxford Hip/Knee Score The Oxford Hip/Knee Score comprise of 12 questions relating to the patient’s experience of pain, ease of joint movement and ease of undertaking normal domestic activities such as walking or climbing stairs. All questions are presented denoting least (or no) symptoms scoring 4 and those representing greatest severity scoring 0. The individual scores are then added together to provide a single score between 0 (worst) and 48 (best). Aberdeen Varicose Vein Score The Aberdeen Varicose Veins Questionnaire (AVVQ) is scored from 0 (best quality of life) to 100 (worst quality of life).
Data Analysis Case-mix adjusted average health gain in terms of the measures described above is estimated for each provider. The adjusted measure takes into account the fact that organisations deal with patients with a differing case-mix, e.g. age, sex, co-morbidity. Further information regarding the methodology can be found at http://www.northgateproms.co.uk/documents.html When interpreting the organisational-level results, it is important that the patterns shown are taken to be a starting point for further investigation rather than giving a definitive conclusion on organisational performance. Extreme results may not be down to clinical reasons. They could also be caused by random variation (irregular and erratic fluctuations or chance factors that, in practical terms, cannot be anticipated, detected, identified, or eliminated); by data quality issues; or by differences. For further information and a national summary see http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295
2
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Groin Hernia Data Completeness Table 1 shows the statistics on the number of submitted PROMs questionnaires for groin hernia procedures (both pre and post operative) by provider for the period between April 2009 and October 2010. Please see the ‘Data Collection’ section on Page 1 of the report for details of the ‘eligible HES episodes’, ‘pre-operative questionnaires (Pre-op Qs)’, ‘linked questionnaires (Qs linked to HES episodes)’ and ‘post-operative questionnaires (Post-op Qs)’. Table 1 PROMs data completeness (April 2009 – October 2010) – groin hernia
Providers
3
England Burton Hospitals Walsall Hospitals Sandwell & West Birmingham Hospitals University Hospital of North Staffordshire The Royal Wolverhampton Hospitals Worcestershire Acute Hospitals University Hospital Birmingham South Warwickshire General Hospitals University Hospitals Coventry & Warwickshire Mid Staffordshire General Hospitals Dudley Group of Hospitals Shrewsbury & Telford Hospital Heart of England NHS BMI - The Droitwich Spa Hospital South Staffordshire PCT Hereford Hospitals The Midlands NHS Treatment Centre Spire South Bank Hospital The George Eliot Hospital
Pre-Op Qs
Qs linked to HES episodes5
Post-Op Qs returned to date6
% PostOp Qs returned out of episodes7
108045
57556
40642
34679
32.1%
223 457 764 734 567 1117 686 422 853 382 731 1149 1194 54 182 324 275 64 357
117 302 287 187 354 460 293 305 391 137 345 867 846 69 101 292 257 142 232
85 218 238 140 273 363 219 271 299 100 258 663 573 38 97 227 162 46 180
77 168 153 136 226 297 173 203 260 84 220 561 426 50 76 158 132 98 144
34.5% 36.8% 20.0% 18.5% 39.9% 26.6% 25.2% 48.1% 30.5% 22.0% 30.1% 48.8% 35.7% 92.6% 41.8% 48.8% 48.0% 153.1% 40.3%
Eligible HES episodes4
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care
3
Only providers with case-mix adjusted scores calculated are shown in this table. For Other providers, please see Table 5 Appendix. The data from April 2009 to March 2010 has been finalised and will not change. Data from April 2010 onwards is currently provisional. 5 These figures are based on questionnaires linked to HES episodes using an algorithm that compares a number of different combinations of patient identifiers. This methodology may be revised or enhanced for future publications. The counts are based upon the pre-operative questionnaire completion date. 6 The number of records affects the statistical reliability of the PROMs measures and caution should be exercised when looking at data for trust with less than 25 records submitted. 7 The counts are based upon the pre-operative questionnaire completion date. 4
3
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
EQ-5D Index Score Figure 1 shows the case mix adjusted change in the average EQ-5D index scores reported (between pre and post-operation) for each West Midlands’ providers of groin hernia operations. Description of the EQ-5D index score can be found from the Definition of PROMs Measures section on Page 1 of this report. Figure 1
Case mix adjusted changes (pre and post operation) in average EQ-5D Index Score with confidence intervals, Groin Hernia Operations, PROMs, Apr 2009 - Oct2010 0.20 0.15
better
0.10 0.05 0.00 -0.05
worse
-0.10
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care
Figure 1 shows that: Case-mix adjusted changes in EQ-5D score for all 19 West Midlands’ providers were positive (i.e. improvement in health). For fifteen of the providers, the improvement was statistically significant (i.e. confidence intervals do not cross 0); There was no statistically significant difference between any of the West Midlands’ providers and the national average on this measure.
4
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Hip replacement Data Completeness Table 2 shows the statistics on the number of submitted PROMs questionnaires for hip replacement procedures (both pre and post operative) by provider during the period between April 2009 and October 2010. Please see the ‘Data Collection’ section on Page 1 of the report for details of the ‘eligible HES episodes’, ‘pre-operative questionnaires (Pre-op Qs)’, ‘linked questionnaires (Qs linked to HES episodes)’ and ‘post-operative questionnaires (Post-op Qs)’. Table 2 PROMs data completeness (April 2009 – October 2010) – hip replacement*
Providers3
England Burton Hospitals Dudley Group of Hospitals Heart of England NHS Hereford Hospitals Mid Staffordshire General Hospitals Robert Jones & Agnes Hunt Orthopaedic & District Hospital Royal Orthopaedic Hospital Sandwell & West Birmingham Hospitals Shrewsbury & Telford Hospital South Warwickshire General Hospitals The George Eliot Hospital The Royal Wolverhampton Hospitals University Hospital of North Staffordshire University Hospitals Coventry & Warwickshire Walsall Hospitals Worcestershire Acute Hospitals
Pre-Op Qs
Qs linked to HES episodes5
Post-Op Qs returned to date6
% PostOp Qs returned out of episodes7
103297
76694
56766
42656
41.3%
410 626 1063 525 530 1702 1531 415 421 580 388 508 672 870 296 1010
364 596 746 410 151 1602 1572 300 330 445 370 370 770 550 119 644
290 440 559 366 90 1288 1169 268 259 362 312 335 509 389 99 519
209 329 370 252 82 934 804 197 198 253 209 197 397 322 76 350
51.0% 52.6% 34.8% 48.0% 15.5% 54.9% 52.5% 47.5% 47.0% 43.6% 53.9% 38.8% 59.1% 37.0% 25.7% 34.7%
Eligible HES episodes4
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care *Please see Page 3 for all the footnotes in this table
5
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
EQ-5D Index Score Figure 2 shows the case mix adjusted change in the average EQ-5D index scores reported (from preoperation to post-operation) for all West Midlands’ providers. Description of the EQ-5D index score can be found from the Definition of PROMs Measures section on Page 1 of this report. Figure 2
Changes (pre and post operation) in ADJUSTED EQ-5D Index Scores with confidence intervals, Hip Replacement Operations, PROMs, Apr 2009 - Oct2010 better
Change in EQ-5D
0.550 0.500 0.450 0.400 0.350
0.300 worse
0.250 0.200
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care
Figure 2 shows that: Case-mix adjusted changes in the average EQ-5D score for all 16 West Midlands’ providers were positive (i.e. improvement in health) and the improvement was statistically significant (i.e. confidence intervals do not cross 0); There was no statistically significant difference between any of the West Midlands’ providers and the national average on this measure.
6
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Oxford Hip Score Figure 3 shows the adjusted change in the average Oxford Hip Score reported (from pre-operation to post-operation) for each West Midlands’ providers. Description of the Oxford Hip score can be found from the section Definition of PROMs Measures on Page 1 of this report.
Change in Oxford Hip Score
Figure 3
Changes (pre and post operation) in average Oxford Hip Score with confidence intervals, Hip Replacement Operations, PROMs, Apr 2009 - Oct2010 26.0 24.0
better
22.0 20.0 18.0 16.0
14.0
worse
12.0
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care
Figure 3 shows that: Case-mix adjusted changes in the average Oxford hip score for all 16 West Midlands’ providers were positive (i.e. improvement in health) and the improvement was statistically significant (i.e. confidence intervals do not cross 0); None of the West Midlands’ providers was significantly different from the national average on this measure.
7
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Knee replacement Data Completeness Table 3 shows the statistics on the number of submitted PROMs questionnaires for knee replacement procedures (both pre and post operative) by provider during the period between April 2009 and October 2010. Please see the ‘Data Collection’ section on Page 1 of the report for details of the ‘eligible HES episodes’, ‘pre-operative questionnaires (Pre-op Qs)’, ‘linked questionnaires (Qs linked to HES episodes)’ and ‘post-operative questionnaires (Post-op Qs)’. Table 3 PROMs data completeness (April 2009 – October 2010) – knee replacement*
Pre-Op Qs
Qs linked to HES episodes5
Post-Op Qs returned to date6
% PostOp Qs returned out of episodes7
116728
91391
62348
48853
41.9%
460 917 1550 494 581 1709 1425 856 440 625 550 730 640 1069 462 1068
465 833 1045 445 200 1648 1279 611 376 572 528 631 694 778 191 624
333 608 826 351 114 1241 1038 541 291 402 432 515 411 478 155 462
250 436 502 258 99 920 632 391 207 262 283 317 390 422 136 360
54.3% 47.5% 32.4% 52.2% 17.0% 53.8% 44.4% 45.7% 47.0% 41.9% 51.5% 43.4% 60.9% 39.5% 29.4% 33.7%
Providers3
Eligible HES episode s4
England Burton Hospitals Dudley Group of Hospitals Heart of England NHS Hereford Hospitals Mid Staffordshire General Hospitals Robert Jones & Agnes Hunt Orthopaedic & District Hospital Royal Orthopaedic Hospital Sandwell & West Birmingham Hospitals Shrewsbury & Telford Hospital South Warwickshire General Hospitals The George Eliot Hospital The Royal Wolverhampton Hospitals University Hospital of North Staffordshire University Hospitals Coventry & Warwickshire Walsall Hospitals Worcestershire Acute Hospitals
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care *Please see Page 3 for all the footnotes in this table
8
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
EQ-5D Index Score Figure 4 shows the case mix adjusted change in the average EQ-5D index scores reported (from preoperation to post-operation) for each West Midlands’ providers of knee replacement operations. Description of the EQ-5D index score can be found from the Definition of PROMs Measures section on Page 1 of this report. Figure 4
Changes (pre and post operation) in ADJUSTED EQ-5D Index Scores with confidence intervals, Knee Replacement Operations, PROMs, Apr 2009 - Oct2010 0.500
Change in EQ-5D
0.450
better
0.400 0.350 0.300 0.250 0.200 0.150
worse
0.100
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care
Figure 4 shows that: Case-mix adjusted changes in the average EQ-5D score for all 16 West Midlands’ providers were positive (i.e. improvement in health) and the improvement was statistically significant (i.e. confidence intervals do not cross 0); University Hospital of North Staffordshire are significantly worse than the England average
9
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Oxford Knee Score Figure 5 shows the case-mix adjusted change in the average Oxford Knee Score reported (from preoperation to post-operation) for each West Midlands’ providers. Description of the Oxford Knee score can be found from the section Definition of PROMs Measures on Page 1 of this report Figure 5
Changes (pre and post operation) in Oxford Knee Score with confidence intervals, Knee Replacement Operations, PROMs, Apr 2009 - Oct2010 Chage in Oxford knee score
20.0 18.0
better
16.0 14.0 12.0 10.0
worse 8.0
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care
Figure 5 shows that: Case-mix adjusted changes in the average Oxford knee score for all 16 West Midlands’ providers were positive (i.e. improvement in health) and the improvement was statistically significant (i.e. confidence intervals do not cross 0); University Hospital of North Staffordshire is significantly worse than the England average and the West Midlands average; Sandwell & West Birmingham are significantly worse than the England average. Burton Hospitals are significantly better than the England average and the West Midlands average.
10
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Varicose Vein Data Completeness Table 4 shows the statistics on the number of submitted PROMs questionnaires for varicose vein procedures (both pre and post operative) by provider during the period between April 2009 and October 2010. Please see the ‘Data Collection’ section on Page 1 of the report for details of the ‘eligible HES episodes’, ‘pre-operative questionnaires (Pre-op Qs)’, ‘linked questionnaires (Qs linked to HES episodes)’ and ‘post-operative questionnaires (Post-op Qs)’. Table 4 PROMs data completeness (April 2009 – October 2010) – varicose vein*
Providers3
England Dudley Group of Hospitals Heart of England NHS Hereford Hospitals Sandwell & West Birmingham Hospitals Shrewsbury & Telford Hospital The Midlands Nhs Treatment Centre The Royal Wolverhampton Hospitals University Hospital Birmingham Nhs Foundation Trust University Hospitals Coventry & Warwickshire Walsall Hospitals Worcestershire Acute Hospitals
Pre-Op Qs
Qs linked to HES episodes5
Post-Op Qs returned to date6
% PostOp Qs returned out of episodes7
54266
23420
18913
12381
22.8%
1034 1243 181 507 447 80 722 902 363 278 735
540 603 136 204 321 50 391 200 90 115 168
510 328 124 197 251 44 304 172 82 103 162
290 165 81 99 187 33 183 102 58 59 95
28.0% 13.3% 44.8% 19.5% 41.8% n/a 25.3% 11.3% 16.0% 21.2% 12.9%
Eligible HES episodes4
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care *Please see Page 3 for all the footnotes in this table
11
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
EQ-5D Index Score Figure 6 shows the case mix adjusted change in the average EQ-5D index scores reported (from preoperation to post-operation) for each West Midlands’ providers of varicose vein operations. Description of the EQ-5D index score can be found from the Definition of PROMs Measures section on Page 1 of this report. Figure 6
Changes (pre and post operation) in ADJUSTED EQ-5D Index Scores with confidence intervals, Varicose Vein Operations, PROMs, Apr 2009 - Oct2010 0.25
Change in EQ-5D
0.20
better
0.15 0.10 0.05 0.00 -0.05
worse
-0.10
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care
Figure 6 shows that: Case-mix adjusted changes in EQ-5D score for all of the West Midlands’ providers were positive. The improvement was statistically significant for nine of the ten providers (i.e. confidence intervals do not cross 0); There was no statistically significant difference between any of the West Midlands’ providers and the national average on this measure.
12
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Aberdeen Varicose Vein Score Figure 7 shows the case mix adjusted change in the average Aberdeen varicose vein scores reported (from pre-operation to post-operation) for each West Midlands’ providers. Description of the Aberdeen varicose vein score can be found from the Definition of PROMs Measures section on Page 1 of this report. Figure 7
Changes (pre and post operation) in Aberdeen Varicose Vein Score with confidence intervals, Varicose Vein Operations, PROMs, Apr 2009 - Oct2010
Change in Aberdeen Score
15.000 10.000 5.000
worse
0.000 -5.000 -10.000 -15.000 -20.000 -25.000
better
Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care
Figure 7 shows that: Case-mix adjusted changes in the average Aberdeen Varicose Vein Score for all 11 of the West Midlands’ providers were negative (i.e. improvement in health). The improvement was statistically significant for seven of the providers (i.e. confidence intervals do not cross 0); There was no statistically significant difference between any of the West Midlands’ providers and the national average on this measure.
13
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Next steps WMQI will be publishing the West Midlands data on a monthly basis on our website (http://www.wmqi.westmidlands.nhs.uk/clinical-measures/proms/), along with relevant commentary on the methodologies and the PROM scores. Please send any comments you have to WMQI@westmidlands.nhs.uk or use the feedback form on our website (http://www.wmqi.westmidlands.nhs.uk/about-wmqi/feedback/). Produced by WMQI NHS West Midlands St Chads Court 213 Hagley Road Edgbaston Birmingham B16 9RG tel: 0121 695 2460 email: WMQI@westmidlands.nhs.uk web: www.wmqi.westmidlands.nhs.uk twitter: @wmqi
14
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Appendix Data quality for providers which are excluded from the case-mix adjusted analysis Table 5 PROMs data completeness (April 2009 – October 2010) – groin hernia, other providers* Eligible HES episodes4
Providers
England West Midlands Hospital Rowley Hall Hospital BMI - The Meriden Hospital Worcestershire PCT Spire Little Aston Hospital Spire Parkway Hospital Shropshire County PCT BMI The Edgbaston Hospital Nuffield Health, Wolverhampton Hospital Birmingham Children's Hospital Nuffield Health, Hereford Hospital Nuffield Health, Shrewsbury Hospital
Pre-Op Qs
Qs linked to HES episodes4
Post-Op Qs returned to date5
% PostOp Qs returned out of episodes6
108045
57556
40642
34679
32.1%
122
39
30
24
19.7%
124
40
30
24
19.4%
62
27
19
18
29.0%
60
36
29
22
36.7%
58
75
45
48
82.8%
53
74
9
56
105.7%
43
15
13
12
27.9%
28
30
13
16
57.1%
21
88
16
47
n/a
20
*
*
*
n/a
19
79
10
40
210.5%
13
50
8
25
192.3%
Qs linked to HES episodes5
Post-Op Qs returned to date6
% PostOp Qs returned out of episodes7
Table 6 PROMs data completeness (April 2009 – October 2010) – hip replacement, other providers* Eligible HES episodes4
Providers
England
Spire Little Aston Hospital Rowley Hall Hospital Kidderminster Nhs Treatment Centre West Midlands Hospital West Midlands Hospital Spire Parkway Hospital Spire South Bank Hospital Bmi - The Droitwich Spa Hospital Bmi The Edgbaston Hospital Bmi - The Meriden Hospital Nuffield Health, Wolverhampton Hospital Nuffield Health, Hereford Hospital University Hospital Birmingham Nhs Foundation Trust
15
Pre-Op Qs
103297
76694
56766
42656
41.3%
72
103
57
44
61.1%
59
36
31
25
n/a
45
0
*
n/a
n/a
41
17
15
10
24.4%
41
17
15
10
24.4%
40
136
35
69
172.5%
32
77
21
58
181.3%
29
62
23
26
89.7%
24
33
13
12
50.0%
22
19
14
*
n/a
10
93
12
50
500.0%
8
90
6
62
775.0%
6
0
0
0
0.0%
PROMs: provisional analysis of the experimental data, April 2009 to October 2010
Table 7 PROMs data completeness (April 2009 – October 2010) – knee replacement, other providers* Eligible HES episodes4
Providers
Pre-Op Qs
Qs linked to HES episodes5
Post-Op Qs returned to date6
% PostOp Qs returned out of episodes7
England
University Hospital Birmingham Nhs Foundation Trust Nuffield Health, Hereford Hospital Nuffield Health, Shrewsbury Hospital Kidderminster Nhs Treatment Centre Spire Little Aston Hospital Spire Parkway Hospital West Midlands Hospital Rowley Hall Hospital Spire South Bank Hospital Bmi - The Droitwich Spa Hospital Bmi - The Meriden Hospital Bmi The Edgbaston Hospital Nuffield Health, Wolverhampton Hospital
*
0
0
0
n/a
*
71
*
45
n/a
*
46
*
26
n/a
116
0
27
n/a
n/a
63
85
41
34
54.0%
54
131
42
51
94.4%
53
42
27
18
34.0%
45
33
28
13
28.9%
39
90
33
55
141.0%
35
77
22
35
100.0%
27
16
11
*
n/a
12
35
6
*
n/a
6
142
*
40
666.7%
Qs linked to HES episodes5
Post-Op Qs returned to date6
% PostOp Qs returned out of episodes7
18913
12381
22.8%
Table 8 PROMs data completeness (April 2009 – October 2010) – varicose vein, other providers* Eligible HES episodes4
Providers
England
54266
Pre-Op Qs
23420
South Staffordshire Pct
*
*
*
*
n/a
Rowley Hall Hospital
*
0
0
0
n/a 11.0%
University Hospital Of North Staffordshire Nhs Trust
290
51
35
32
South Warwickshire Nhs Foundation Trust
98
7
6
*
n/a
Mid Staffordshire Nhs Foundation Trust
95
14
12
9
9.5%
George Eliot Hospital Nhs Trust
59
33
26
23
39.0%
Burton Hospitals Nhs Foundation Trust
31
19
10
9
29.0%
Shropshire County Pct
17
8
8
7
41.2%
0
0
0.0%
West Midlands Hospital 9 0 Data source: Hospital Episode Statistics (HES) / PROMs, The NHS Information Centre for Health and Social Care *Please see Page 3 for all the footnotes in this table
16
PROMs: provisional analysis of the experimental data, April 2009 to October 2010