Anna Ziekenhuis is now using PROMs in multiple departments

The Orthopaedics Department at Anna Ziekenhuis started working with OnlinePROMS in 2014. They now measure PROMs in eight different specialties within the hospital. The first PREMs have also started, including submission to Zorgkaart, an online platform that provides independent information to help people make choices about healthcare.

Walter van der Weegen

In what ways are PROMs part of your work?

‘They are used in various areas, but I think the most important aspect is that we use them to provide direct feedback to the department. Complications and prosthesis survival were often the primary focus, but thanks to PROMs, we are increasingly considering what the procedure means for the patient. This used to happen on a small scale, often as part of a study, but we now measure PROMs in almost all orthopaedic procedures. In addition to PROMs, we are also increasingly looking at PREMs. It’s not only the outcome of the treatment that’s important, but also the experience of the care we provide as a hospital and as a team. Since November 2020, we have also been sending these PREM results directly to Zorgkaart.’

We also use PROMs to benchmark ourselves nationally through the Dutch Arthroplasty Register (LROI) and in discussions with health insurers.

Since November 2020, we have also been sending these PREM results directly to Zorgkaart.

Walter van der Weegen is a scientific researcher at the Anna Ziekenhuis in Geldrop. He primarily works in the orthopaedics department but is also involved in various PROMs and Value-based Healthcare projects in the hospital. He believes that research and data are at the foundation of quality improvement.

PROMs for individual patients

The hospital notes that it is still difficult to use PROMs on a one-on-one basis during consultations. However, the recent development of customised patient-level reports may change this: ‘The results must be instantly clear: what we’re looking at and what the scores actually mean.’
‘Another way of using the data is through the signal function. No one has time to review all PROMs – even though you know outliers will appear from time to time. The system supports this by issuing a signal when a patient exceeds a pre-set threshold value. We will then often get in touch. The score is not always related to the treatment we provided, but the contact is greatly appreciated and teaches us more about the issues that concern patients in the period after surgery, for example.

De Patient Journey App

Optimal preparation for appointments

‘Recently, we’ve also been increasingly using PROMs to get a clear picture of the patient before they visit the hospital. This helps us see what their symptoms are, what they want to discuss and what’s important to them. We aim for our consultations to focus more on the patient as a whole, not just their knee, for instance. We are currently testing this with scientific research, taking it a step further by using AI (artificial intelligence) to predict certain types of symptoms, and providing relevant information via Patient Journey before the consultation.’

What do you think of Value-based Healthcare (VBHC)?

‘It’s an interesting concept, but also a complex one. Unfortunately, there is no single, clear outcome. What are the exact costs of a treatment? What constitutes an objective outcome? When and how do you measure the outcomes? It’s encouraging that an increasing number of national and international guidelines are helping to reach consensus on these questions. In that regard, PROMs provide a good starting point: the data is easy to collect, uniform, validated, and structured.
Another issue is that the results are not static. Five to 10 years ago, with certain forms of cancer we focused on survival – today, the emphasis is on quality of life. This shift is made possible by new, innovative, though sometimes expensive, treatments. That is where VBHC’s two parameters – outcomes and costs – come into play.

Tips for other hospitals

Walter also has some tips for hospitals that want to start measuring PROMs and PREMs. ‘Starting something new is easy. We called you, indicated what we wanted to measure, and it was immediately implemented in the system. But when you start setting up the process, everyone has to get involved. They all need to know what PROMs are, why they are measured, what it means for the patient and for us as a hospital.
I still regularly visit the employees of the departments involved to share PROMs and PREMs results. Both the care provided and the results achieved reflect all our efforts.’

Would you like to find out more?

Curious about how PROMs can help you gain more insight and overview when scheduling medical staff? Contact us! We would be happy to tell you more about it.