HES Data Request Service Application Form, Appendix E, V2

Data Linkage and Extract Service

Patient Reported Outcome Measures (PROMs) Data Form PROMs application form

Introduction

This data form allows you to request an extract of Patient Related Outcome Measures (PROMs) data with the option of including linked Hospital Episode Statistics (HES) data. Please note that PROMs data is only available for non-commercial purposes, such as academic research or in connection with delivering services to the NHS.

PROMs data includes the EQ-5D visual analogue scale and index for all participating procedures. For hip and knee replacements it includes the Oxford Hip Score and Oxford Knee Score, and for varicose veins it includes the Aberdeen Varicose Veins Questionnaire score.

PROMs Consent

Due to the consent model as applied to PROMs data, customers who have existing HES extracts with patient-identifiable information must declare that they will not attempt to link the PROMs data in order to identify individual PROMs responses. Those customers who do wish to link PROMs to identifiable HES data must secure specific approval under section 251 of the NHS Act 2006 in order to do so.

Declaration: • I do not currently hold HES identifiable data. • I hold HES identifiable data but do not wish to link this to PROMs data. • I hold HES identifiable data and wish to link this to PROMs data. I understand that I must obtain specific section 251 approval in order to do this.

Signature: Date:

PROMs Extract Specification Form

(Please either type or write in black ink, as this form will be photocopied)

Requested fields

This section allows you to indicate which fields you require (please select as appropriate):

PROMs data linked to HES inpatient extract only All PROMs data

Procedures

Fields can be filtered by procedure type, if required. Please indicate which records you would like to receive:

Default: All procedures Hip replacements Knee replacements Groin hernia procedures Varicose vein procedures

Additional filters (If you wish to any additional filters please use the space below)

PROMs data

Below is a list of the fields that you can request from the PROMs data set. For further details regarding these fields please refer to the PROMS Data Dictionary available at www.hscic.gov.uk/hesdatadictionary

General data PROMs Serial Number (PROMS_SERIAL_NO) PROMs Procedure Code (PROMS_PROC_CODE) PROMs Procedure Group (PROMS_PROC_GROUP) Patient Death (PATIENT_DEATH) Complete (COMPLETE) Q1 Complete (Q1_COMPLETE) Q1 Completion Date (Q1_COMPLETED_DATE) Q1 Assisted (Q1_ASSISTED) Q1 Assisted by (Q1_ASSISTED_BY) Q1 Symptom Period (Q1_SYMPTOM_PERIOD) Q1 Previous Surgery (Q1_PREVIOUS_SURGERY) Sex of Patient (GENDER) Co-morbidities (12 fields showing whether the patient has indicated any co-morbidities eg diabetes and cancer) Q1 Living Arrangements (Q1_LIVING_ARRANGEMENTS) Q1 General Health (Q1_GENERAL_HEALTH) Q1 Disability (Q1_DISABILITY) Q1 Provider Code (Q1_PROCODE) Q2 Complete (Q2_COMPLETE) Q2 Completion Date (Q2_COMPLETED_DATE) Q2 Assisted (Q2_ASSISTED) Q2 Assisted by (Q2_ASSISTED_BY) Q2 Surgery Date (Q2_SURGERY_DATE) Q2 Surgery Complications (four fields showing whether the patient encountered any complications post surgery, eg allergy and wound problems) Q2 Readmitted (Q2_READMITTED) Q2 Further Surgery (Q2_FURTHER_SURGERY) Q2 Satisfaction (Q2_SATISFACTION) Q2 Success (Q2_SUCCESS) Q2 Living Arrangements (Q2_LIVING_ARRANGEMENTS) Q2 General Health (Q2_GENERAL_HEALTH) Q2 Disability (Q2_DISABILITY)

Scoring data

EQ-5D: EQ-5D Index Change (EQ5D_INDEX_CHANGE) EQ-5D Health Scale Change (EQ5D_SCALE_CHANGE) Q1 EQ-5D Profile (Q1_EQ5D_PROFILE) Q1 EQ-5D Index (Q1_EQ5D_INDEX) Q1 EQ-5D Health Scale (Q1_EQ5D_HEALTH SCALE) Q1 EQ-5D Responses Q2 EQ-5D Profile (Q2_EQ5D_PROFILE) Q2 EQ-5D Index (Q2_EQ5D_INDEX) Q2 EQ-5D Health Scale (Q2_EQ5D_HEALTH_SCALE) Q2 EQ-5D Responses Q1 EQ-5D Health Scale Complete (Q1_EQ5D_SCALE_COMPLETE) Q1 EQ-5D Profile Complete (Q1_EQ5D_PROFILE_COMPLETE) Q2 EQ-5D Health Scale Complete (Q2_EQ5D_SCALE_COMPLETE) Q2 EQ-5D Profile Complete (Q2_EQ5D_PROFILE_COMPLETE)

Procedure specific: Procedure Specific Score Change (SCORE_CHANGE) Q1 Score (HR_Q1_SCORE, KR_Q1_SCORE, GH_Q1_SCORE, VV_Q1_SCORE) Q1 All Condition Specific Responses Q1 Score Complete (HR_Q1_SCORE_COMPLETE KR_Q1_SCORE_COMPLETE VV_Q1_SCORE_COMPLETE) Q2 Score (HR_Q2_SCORE, KR_Q2_SCORE, GH_Q2_SCORE, VV_Q2_SCORE) Q2 All Condition Specific Responses Q2 Score Complete (HR_Q2_SCORE_COMPLETE KR_Q2_SCORE_COMPLETE VV_Q2_SCORE_COMPLETE) VV Q1 Total Score (VV_Q1_TOTAL_SCORE) – available for varicose veins only VV Q1 Max Score (VV_Q1_MAX_SCORE) – available for varicose veins only VV Q2 Total Score (VV_Q2_TOTAL_SCORE) – available for varicose veins only VV Q2 Max Score (VV_Q2_MAX_SCORE) – available for varicose veins only

Note: There is no condition-specific data for groin hernia procedures

Metadata

A number of additional fields exist within the data set that provide details relating to the form and scoring versions. For a full list of these fields please refer to Annex 1.

By default, these fields will not be provided. Please indicate here if you require these fields: Metadata required

Field details (If you wish to provide any further instructions relating to the fields you require please use the space below)

Annex 1: metadata field list

Please refer to the PROMs Data Dictionary available at www.hscic.gov.uk/hesdatadictionary for further information regarding the below fields: 1. Status Date (STATUS_DATE) 2. Modified Date (MODIFIED_DATE) 3. EQ-5D Version (EQ5D_VERSION) 4. Q1 Score Complete (Q1_SCORE_COMPLETE) 1. Q1 Language (Q1_LANGUAGE) 2. Q1 Scan Date (Q1_SCAN_DATE) 3. Q1 EQ-5D Version (Q1_EQ5D_VERSION) 4. Q2 Score Complete (Q2_SCORE_COMPLETE) 5. Q2 Form Version (Q2_FORM_VERSION) 6. Q2 Language (Q2_LANGUAGE) 7. Q2 Scan Date (Q2_SCAN_DATE) 8. Q2 EQ-5D Version (Q2_EQ5D_VERSION) 9. Status (STATUS)

Acknowledgements

Any and all copyrights in the EQ-5D questions, their order, layout and images vest in the EuroQol Group. The EuroQol Group reserves all rights. © 1992 EuroQol Group. EQ-5D™ is a trademark of the EuroQol Group [http://www.euroqol.org].

Any and all copyrights in the Oxford Hip Score and Oxford Knee Score questions, their order and layout vest in Isis Innovation Limited. Isis Innovation Limited reserves all rights. © 1996 Isis Innovation [http://www.isis-innovation.com/licensing/healthoutcomes/oxford_hip_and_knee.html].

For more details of the terms and conditions of use of the Department of Health PROMs questionnaires, see the Department of Health website [http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_0 91815].