#POS2015 A: @DrFlissMurtagh. Likely to run into problems when phased with currency issues. Encourage teams to 'leap' rather than be pushed

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Q: Little engagement in re: data capture onto IT systems (from docs in particular!) How can you engage clinical staff?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Q: what about IT and data presentation? Suppliers involved. Keen to discuss.

— Becky Baines (@Becbaines) February 5, 2015

@B_CP_Antunes @CSI_KCL Thanks Barbara. It's a great day. Learning loads. #POS2015

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Q: narrative story telling really important in #hpm. How can we keep developing that? Fit outcome measure data collection into that

— Becky Baines (@Becbaines) February 5, 2015

@Becbaines @CSI_KCL Absolutely amazing twitter coverage of #POS2015 well done you!!

— Bárbara Antunes (@B_CP_Antunes) February 5, 2015

#POS2015 In Australia, primary care have starred using phase of illness and other terms. Now well established.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Resource pack from oacc@kcl.ac.uk. Will be available before April when pilots start. Small cost. @hospiceuk involved.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Services are likely to have tariff funding which has a per phase component and per diem component. Accurate measures of phase key

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Q: what about intervals? National drivers will be around phase rather than time. Tariff is likely to vary with phase.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Which IPOS questions will be used in national data set? Pain, SOB, "at peace" and measure of information. 5 or 6 items.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 To implement: need senior management to support, need to look at how staff on the ground can grow and learn.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Example given of change in scores over 2 assessments, shows helpful improvement in symptoms and concerns.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Needed to prove to teams that outcome measures have use in clinical practice. Real time feedback of data is really helpful.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 What were the barriers? Worries about not enough staff, time and fear of added work. Training was adapted to individual teams.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Have 2 quality improvement facilitators. Worked with teams in first instnce. Trained and re-trained. Adapted training with feedback

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 OACC implementation started in July 2014. Phased approach to implementation. Started with Karnofsky and Phase of illness.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 OACC recommends: PC phase, Karnofsky, IPOS, Barthel, Views on Care, Carer measures.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Next is a discussion about OACC - the Outcome Assessment and Complexity Collaborative project. 3 yr funded project in S London.

— Becky Baines (@Becbaines) February 5, 2015

Outcome Assessment & Complexity Collaborative (OACC) project presented by @jana_witt #POS2015 #hpm #palliative care http://t.co/P2jpcKd0Ok

— CSI Palliative Care (@CSI_KCL) February 5, 2015

#POS2015 Pain seems to be symptom that gives legitimacy to PC input. Often times patients have other concerns, eg. Family, anxiety, nausea

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Great case study from @DrFlissMurtagh re: patient priority. Worried about husband, not pain as referral had suggested.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Can do on a per contact basis too or if phase of illness changes.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Can also use POS in conjunction with phase of illness. Eg. When people are stable, they need less assessment.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 How often should the data be captured? First assessment, then very 3-5 days if IP, every 7-21 days in community.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Capture info on paper or on your chosen IT solution.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 "Have you felt at peace?" Pts seem to really like this question.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Useful 2 sides of A4 prompt sheet. Sensible questions to prompt. Physical and psychological questions.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Can be used to help prioritise case load. If pts have significant symptom burden.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 How can POS be incorporated in clinical practice? Start simple, start small. Start with keen individual staff members.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Can also give to pts to complete between assessments. Looking to develop app or web based solution.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Can use IPOS in advance of meeting, eg before OPD, hospital or Comm visit. Can complete on own or with help from family/staff.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 How can we implement this in practice? #OACC helps to set things up with training and feedback.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 So IPOS sits nicely within national UK plans.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Phase of illness, Karnofsky score, selected IPOS questions, Views on Care derived from SKIPP, family carer measures.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 National UK proposal for outcome measures from @PHE_uk. Need to collect 1 set of data.

— Becky Baines (@Becbaines) February 5, 2015

How can you use IPOS in clinical practice and what can it deliver? @DrFlissMurtagh POS training day #POS2015 #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 5, 2015

#POS2015 What matters most to patients? Good symptom control, family support, reduction in burden, peace.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Next up: @DrFlissMurtagh showing us the nitty gritty of POS in practice.

— Becky Baines (@Becbaines) February 5, 2015

@Becbaines @DrFlissMurtagh #POS2015 but can it be embedded in electronic records like SystmOne?

— Barbara Gale (@barbaragaleceo) February 5, 2015

@JonathanKoffman chairs ‘Embedding outcome measurement research into clinical practice’, #POS2015 #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 5, 2015

Great to see hashtag #POS2015 being encouraged by @ij_higginson #SoMerules!

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 A from @ij_higginson: also can pick up people who are not doing well more quickly.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Answer from Claudia Bausewein. If the patient is better that's what is important.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Answer from @ij_higginson. No way to PROVE that change is down to one intervention. In research, one arm vs another or time control

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Great question about multi agency care in the home setting. How do you prove that change is down to #hpm input?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 IPOS version available which looks at more detailed symptom questions for patients with neurological conditions.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Now @DrFlissMurtagh talking about how IPOS seems much easier to use in clinical practice. The free text items helpful too.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 In Germany they have found that IPOS seems to be easier for patients - easier, quicker and shorter

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Team in Singapore have been using POS for 10 years. About to switch to online version.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Use measures to help the patient in front of you, but also to direct service development.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 MORECARE suggested easy, applicable across setting, getting timing right, ideally used in research as well.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 When to measure? Choose measures for different settings?

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Aims to be clinically relevant, acceptable, validated, stable, reliable, show meaningful change, brief.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 MyPOS can be used in Myeloma care. Options for those with neurological disease.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Website has been set up to allow easy downloads of POS materials. Set up networking in local groups. E-learning materials to come

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Caregiver burden affects the score for POS. Makes it less valid.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 IPOS is the 2015 version. New version adds "peace" section. Based on question from African version.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Different versions from 1986 to now. Different languages. Different people completing forms: patients, family, staff.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Revised POS with 10 core items. 5 pt Likert scale. Free report space to capture person centred aspects.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Started with STAS. 16 items, completed by professionals. 0-5 scale. Challenges with existential questions in particular.

— Becky Baines (@Becbaines) February 5, 2015

Now, back to @ij_higginson for an overview of POS family of measures #POS2015 #hpm

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Mularski RV published in 2007. POS, QUAL-E and QODD were recommended.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Can the measure elect clinically meaningful change? Also need to be short and easy to use in clinical practice.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Need validity and reliability. Inter-rather reliability really important.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Don't just store the data - use it. Track on graphs and reflect back to patient.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Who completes rating? Gold standard is patient themselves. Back up staff or family member.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Generic measures available eg: SF36, EuroQol. Often long and burdensome.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 What did professionals want? Quick. 6-10 questions. Web based. Physical, psychological and social measures.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 106 different tools were used: ESAS, POS, PPS etc. ie Too many to be used to compare information.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Barriers were: time constraints, perceived as too burdensome, lack of training.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Research published in 2011. Professionals attitudes to outcome measures in Europe and Africa. Tools not being commonly used.

— Becky Baines (@Becbaines) February 5, 2015

#POS2015 Useful outcome measures: reduction in symptoms, quality of life, improvement in mental health.

— Becky Baines (@Becbaines) February 5, 2015

Outcome = "change in patients current and future health status that can be attributed to preceding healthcare" #hpm #POS2015

— Becky Baines (@Becbaines) February 5, 2015

In NHS, outcome measures used post hip/knee replacements already #hpm #POS2015

— Becky Baines (@Becbaines) February 5, 2015

Next up: Claudia Bausewein. #POS2015 #hpm

— Becky Baines (@Becbaines) February 5, 2015

Focus on patient benefit, learning NOT regulatory and top down process stuff #POS2015 #hpm

— Becky Baines (@Becbaines) February 5, 2015

@ij_higginson welcomes delegates to clinical day for using POS family of measures, #POS2015 #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 5, 2015

@CSI_KCL Ok found it! #POS2015

— Becky Baines (@Becbaines) February 5, 2015

@CSI_KCL Someone else using this hashtag. Any other options?

— Becky Baines (@Becbaines) February 5, 2015

We look forward to welcoming national & international delegates for our sold out #POS2015 training days, #clinical day underway soon #hpm

— CSI Palliative Care (@CSI_KCL) February 5, 2015