Andrew Bateman PhD MCSP

Director of Research, Oliver Zangwill Centre for Neuropsychological Rehabilitation

Clinical Lead for NeuroRehab in CCS

Affiliated Lecturer, Dept of Psychiatry,

University of Cambridge

NHS East of England CARA Post-Doctoral Fellow

NIHR CLAHRC for

Cambridgeshire & Peterborough

Community Rehab Use of the

EQ5D-5L: disordered thresholds

and DIF identified using Rasch

Collaboration for Leadership in Applied Health Research and Care

Innovation by Design

CCGs now responsible for commissioning

services, to include outcomes in contract?

The EQ5D-5L

Describes a health

state “today”

Health related quality

of life

Health economics

Also an overall health

“thermometer”

Collaboration for Leadership in Applied Health Research and Care

Demographics of the first 2000:

Group 1 2 3 .

N 299 882 725

Age 48 (17-60) 72 (61-80) 86 (81-102)

Gender %M 44 41 34

Collaboration for Leadership in Applied Health Research and Care

Collaboration for Leadership in Applied Health Research and Care

Collaboration for Leadership in Applied Health Research and Care

Threshold map for rescored data, including the VAS

Usual activities

Usual activities

Collaboration for Leadership in Applied Health Research and Care

Collaboration for Leadership in Applied Health Research and Care

Collaboration for Leadership in Applied Health Research and Care

Clinical and Management

questions

• Am I wasting time * asking pointless questions?

*patient and staff

• Am I detecting the things I need to detect?

• Q (as per Wade’s comments)

• I (advances need translating)

• P (time)

• P (performance)

Collaboration for Leadership in Applied Health Research and Care

A nuanced analysis is needed. Note that some people in rehab deteriorate:

This is expected because of e.g., increased insight, or because

they have a Health condition that is indeed fluctuating.

Also see Kahn et al 2007, Valderas et al 2011

Future analyses Exploring datasets – fit to rasch model?

RMSEA for large datasets

Locality differences, link to staffing density?

Comparison between health conditions

Repeated measurement data calibrated for

age effects

Automate analysis into performance

dashboard

Refs http://www.scoop.it/t/eq-5d

Collaboration for Leadership in Applied Health Research and Care

So problem #1 is that we haven’t

really sorted out outcome

measurement (yet) Importance of proms

Importance of prems

Importance of data collation system in CR

EMPHASISED in the NHS Outcomes Framework

but analysis approach not established

Need for ongoing collaborations with

psychometric and statistical colleagues

Collaboration for Leadership in Applied Health Research and Care

Conclusion

Some problems (with bias and thresholds)

but good targetting

Generic PROMS like EQ5D useful for

thinking about prioritising services to

meet needs of patients

Collaboration for Leadership in Applied Health Research and Care

Thank you for your attention!

Andrew.bateman@ozc.nhs.uk www.ozc.nhs.uk

When shall we meet next?

Society for Research in Rehabilitation www.srr.org.uk

OZC Anniversary Conference 5 July 2013, Newmarket

WFNR, Maastricht, 8 July 2013

WFNR, Cyprus, July 2014

OZC training events – see flyer – get on distribution list

Keep in touch!

Twitter @ozcboss

LinkedIn

Cost of rehab and

a measurement fallacy

http://www.rasch.org/memo50.htm