Addressing missing data in patient-reported outcome measures (PROMs): implications for comparing provider performance

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Publication details

DatePublished - Jul 2014
PublisherCentre for Health Economics, University of York
Place of PublicationYork, UK
Number of pages24
Original languageEnglish

Publication series

NameCHE Research Paper
PublisherCentre for Health Economics, University of York


Patient-reported outcome measures (PROMs) are now routinely collected in the English National Health Service (NHS) and used to compare and reward hospital performance within a high-powered pay-for-performance scheme. However, PROMs are prone to missing data. For example, hospitals often fail to administer the pre-operative questionnaire at hospital admission, or patients may
refuse to participate or fail to return their post-operative questionnaire. A key concern with missing PROMs is that the individuals with complete information tend to be an unrepresentative sample of patients within each provider, and inferences based on the complete cases will be misleading. This study proposes a strategy for addressing missing data in the English PROMs survey using multiple imputation techniques, and investigates its impact on assessing provider performance. We find that inferences about relative provider performance are sensitive to the assumptions made about the reasons for the missing data.

    Research areas

  • Missing data, Multiple Imputation, Patient-reported outcome measures, Provider performance, Missing not at Random

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