Why the NHS recommends Recovering Quality of Life (ReQoL-10) for use in Community Mental Health services

Patient Reported Outcome Measures (PROMs) are tools (usually in a questionnaire format) that help to assess an individual’s mental health and wellbeing needs and measure change. Measuring outcomes can help clinicians and services better understand the impact of 1:1 interventions; ensure services are meeting the needs of different service users; and monitor and improve effectiveness, efficiency and quality of the service offered to its service users.  It is important as it helps to understand the benefit and impact people receive from their mental health services.

In October 2021, NHS England and NHS Improvement established a task and finish group to look at a consistent approach to outcome measurement and recommend which PROMs should be used across CMH services for adults, including older adults, with severe mental illness. The group looked at a large number of PROMs and assessed against agreed selection criteria which included acceptability; validity; reliability; interoperability; and burden.

The group recommended the use of three PROMs, including Recovering Quality of Life (ReQoL-10).  ReQoL-10 was chosen because:

• It is recovery focused and can be used to assess the key recovery domains of connectedness, hope, identity, meaning and empowerment (CHIME) for people with different mental health conditions.  

• It was co-produced and tested with over 6,000 service users.  

• It provides an understanding of the factors contributing to service user’s own personal recovery 

• Nationally, it can be used to benchmark and build evidence and demonstrate good quality.  

The other PROMs recommended by the group were Goal Based Outcomes (GBO) and DIALOG. Each fulfils a different purpose and it is not expected that all three will be used at the same time and by the same care professional. The goal is for services to start embedding at least one of three PROMs in their systems in 22/23 with the aim of embedding all three in CMH services by the end of 23/24. Nationally, there will be an analysis of the data through the Mental Health Services Data Set (MHSDS) along with the development of supporting resources. 

The ReQoL-10 questionnaire has been developed into a visualisation tool which can now be accessed online https://reqol-visualisation-tool.group.shef.ac.uk/ Further resources can be accessed here: https://www.reqol.org.uk/p/overview.html 

One of the aims of the YH ARC Health Economics, Evaluation and Equality Theme has been to support NHS Trusts to meaningfully implement the data in the NHS to improve health outcomes for patients with mental health conditions through the implementation and use of the ReQoL. 

This blog was written by Dr Lizzie Taylor Buck and Amanda Lane, Health Economics, Evaluation and Equality theme, Yorkshire and Humber ARC.

New ReQoL paper - An item response theory analysis of an item pool for the recovering quality of life (ReQoL) measure

Dr Anju Devianee Keetharuth

An item response theory analysis of an item pool for the recovering quality of life (ReQoL) measure

ReQoL-10 and ReQoL-20 have been developed for use as outcome measures with individuals aged 16 and over, experiencing mental health difficulties. 

Purpose

ReQoL-10 and ReQoL-20 have been developed for use as outcome measures with individuals aged 16 and over, experiencing mental health difficulties. This paper reports modelling results from the item response theory (IRT) analyses that were used for item reduction.

Methods

From several stages of preparatory work including focus groups and a previous psychometric survey, a pool of items was developed. After confirming that the ReQoL item pool was sufficiently unidimensional for scoring, IRT model parameters were estimated using Samejima’s Graded Response Model (GRM). All 39 mental health items were evaluated with respect to item fit and differential item function regarding age, gender, ethnicity, and diagnosis. Scales were evaluated regarding overall measurement precision and known-groups validity (by care setting type and self-rating of overall mental health).

Results

The study recruited 4266 participants with a wide range of mental health diagnoses from multiple settings. The IRT parameters demonstrated excellent coverage of the latent construct with the centres of item information functions ranging from − 0.98 to 0.21 and with discrimination slope parameters from 1.4 to 3.6. We identified only two poorly fitting items and no evidence of differential item functioning of concern. Scales showed excellent measurement precision and known-groups validity.

Conclusion

The results from the IRT analyses confirm the robust structure properties and internal construct validity of the ReQoL instruments. The strong psychometric evidence generated guided item selection for the final versions of the ReQoL measures.  The results were also used in developing a health state classification for the ReQoL-Utility Index (ReQoL-UI) so that the ReQoL measures can be used to generate quality adjusted life years to reflect benefits of mental health interventions in cost effectiveness analyses

For the full article, please visit here.

To visit the ReQoL website, please click here.

New Instructions for the remote use of ReQoL-10 ReQoL-20 during routine clinical contact

For many mental health professionals, the coronavirus pandemic will have had a profound impact on their clinical practice which may now include a greater number of online or telephone contacts. For many, the collection of patient reported outcome measures (PROMs) such as ReQoL is an important and integral part of the support they offer. In response to queries from members of our Community of Practice, we have developed guidance on the practicalities of collecting ReQoL remotely (e.g. via telephone or video link). We hope that, in the coming months, as we all get to grips with new communication platforms and different ways of working, we can continue to use the CoP on-line forum to share what is working and learn from each other.

The following instructions are for the use of ReQoL-10 and ReQoL-20 questionnaires during remote clinical contact (i.e. routine clinical contact via telephone or video). These instructions are intended for use by healthcare professionals.

Please download the instructions here.

The instructions have been developed with our partners from Oxford University Innovation (UoO) who manage the ReQoL licence. Our ScHARR contact is Dr Lizzie Taylor Buck.

International Experts Launch a Foundational Set of Standards to Measure and Improve Psychotic Disorders Care Globally

Recovering Quality of Life Measure (ReQoL-20) chosen by an international panel of experts for the new set of standards to measure and improve psychotic disorders globally. 

The International Consortium for Health Outcome Measurement (ICHOM) have announced the release of their new standard set of measures for Psychotic Disorders. As part of this new standard set the Recovering Quality of Life outcome questionnaire (ReQoL-20) has been chosen as the measure for tracking 3 aspects of psychotic disorders - Quality of Life, Personal recovery, and Positive and negative symptoms. HEDS Dr Anju Keetharuth was involved in the development of the ICHOM Standard Set for Psychotic Disorders in partnership with ICHOM,

The ICHOM Standard Set for Psychotic Disorders is the result of hard work by an international group (from Europe, the Americas, Asia and Australia) of leading psychiatrists, psychologists, mental health experts, measurement experts, and service user experts. The new standard set represents the outcomes that matter most to adults and adolescents (age 12 upwards) with psychosis. This marks an important step towards promoting data quality and availability whilst strengthening mental health care for this group.

The development of the ReQoL was led by researchers at School of Health and Related Research (ScHARR), the University of Sheffield and is exclusively available for licence from the Clinical Outcomes team at Oxford University Innovation. The ReQoL has grown rapidly in its recognition as a quality of life measure for assessment with people experiencing  mental health difficulties. International recognition of the ReQoL is demonstrated by the rapid growth of the library of translations, with currently 18 available from Clinical Outcomes.

New HEDS Discussion Paper - Estimating a preference-based index for mental health from the Recovering Quality of Life (ReQoL) measure : valuation of ReQoL-UI

Anju Devianee Keetharuth, Donna Rowen, Jakob Bue Björner and John Brazier

Dr Anju Devianee Keetharuth

Abstract

Objectives There are increasing concerns about the appropriateness of generic preference-based measures to capture health benefits in the area of mental health. This study estimates preference weights for a new measure, Recovering Quality of Life (ReQoL-10), to better capture the benefits of mental health care.

Methods Psychometric analyses of a larger sample of mental health service users (n = 4266) using confirmatory factor analyses and item response theory (IRT) were used to derive a health state classification system and inform the selection of health states for utility assessment. A valuation survey with members of the UK public representative in terms of age, gender and region was conducted using face-to-face interviewer administered time-trade-off (TTO) with props. A series of regression models were fitted to the data and the best performing model selected for the scoring algorithm.

Results The ReQoL-UI classification system comprises six mental health items and one physical health (PH) item. Sixty-four health states were valued by 305 participants. The preferred model was a random effects model, with significant and consistent coefficients and best model fit. Estimated utilities modelled for all health states ranged from -0.195 (state worse than dead) to 1 (best possible state).

Conclusions The development of the ReQoL-UI is based on a novel application of IRT methods for generating the classification system and selecting health states for valuation. Conventional TTO was used to elicit utility values that are modelled to enable the generation of QALYs for use in cost-utility analysis of mental health interventions.

Download the HEDS Discussion Paper here

New Project - Valuing health benefits for children and adolescents: qualitative research examining the impact of perspective and respondents' priorities around adult and child health

HEDS have started work on a new project which will work on providing important information about why people's values differ when valuing child and adolescent health states. This will involve exploring the impact of framing of perspective, elicitation technique, and wider views around child and adult health. This work will be informative for researchers and policy makers around how to elicit and interpret utility values for child and adolescent health states.

The project will undertake qualitative research to:
a) Better understand how framing around the perspective of health states impacts on values for child and adolescent health states elicited from members of the UK adult general population.
b) Understand how this is impacted by general attitudes to child and adult health and the prioritisation of child versus adult health. 

The project team are:
Donna Rowen, Phil Powell, Aki Tsuchiya and John Brazier

The research is funded by EuroQol Group and is taking place at the University of Sheffield, in collaboration with Oliver Rivero-Arias at the University of Oxford. 

Final edition of the CLAHRC YH Health Economics and Outcomes Measurement (HEOM) Newsletter is out

The latest edition of the CLAHRC Yorkshire and The Humber Health Economics and Outcomes Measurement (HEOM) Newsletter is now available to read - you can view it here 

It features an update on their ReQoL Implementation work, including how to get  involved with our ReQoL Community of Practice. Further information on our collaborative work with local decision makers. A sample of some of the 28 papers we have published and how they link to the project’s 3 key objectives.

If you have not received a copy of issues 1 - 7 of the newsletter, please visit the CLAHRC YH HEOM Theme web pages to download your copy http://tinyurl.com/y9rou6c3

CLAHRC YH Health Economics and Outcomes Measurement (HEOM) Newsletter

ReQoL - Focus of UoS research feature

A team led by Professor John Brazier, together with colleagues from ScHARR – Dr Anju Keetharuth, Dr Jill Carlton, Dr Lizzie Taylor Buck and Janice Connell – and Professor Michael Barkham from the Department of Psychology, are the focus of one of the University's current research features, for their work with ReQoL.

For the full feature, please see link below.

https://www.sheffield.ac.uk/research/features/recovering-quality-life

Visit the ReQoL website

ReQoL in Practice Event Report

ReQoL

The report of the first national event capturing the shared learning and knowledge about implementing ReQoL. The event was hosted by the Yorkshire and Humber NIHR CLAHRC and ScHARR.

You can read the report here

Issue 6 of the CLAHRC YH HEOM Newsletter is now out

HEOM Newsletter

Issue 6 of the CLAHRC YH HEOM Newsletter is now out.  In this issue you can read about:

• Dr Aimée Fox from the University of York, provides an overview of recent work into evaluating a model of care referred to as ‘Core 24’, including the findings.  
• Dr Matt Franklin explains the Sheffield Test Bed: Falls-prevention care pathway, the modelling-based approach chosen to perform an exploratory economic evaluation of a falls-prevention care pathway and the three key aspects it incorporated.  
• Health Economists from the University of Sheffield (ScHARR) and University of York (CHE) discuss the paper they are developing titled "An educational review about using cost data for the purpose of cost-effectiveness analysis".  
• Dr Lizzie Taylor Buck who invites you to the first national ReQoL in Practice event being held in Sheffield on the 29th November 2018. A link to register for the event can be found here

If you have not received a copy of issues 1, 2, 3, 4 or 5 of our newsletter, please visit the CLAHRC YH HEOM Theme webpages to download your copy at http://tinyurl.com/y9rou6c3

ReQoL - Patient Reported Outcome Measure

ReQoL

ReQoL is a new Patient Reported Outcome Measure, developed to assess the quality of life for people with different mental health conditions.  ReQoL was developed by the Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU) and the CLAHRC-YH, and was launched at the House of Parliament in October 2016. It places service users at the heart of their recovery and provides practitioners with a user friendly, valid and reliable measure to aid decision making and outcome monitoring.

Since the launch, many organisations have started using ReQoL-10 and ReQoL-20. Over 73 licences have been granted for a wide range of organisations including 23 mental health trusts which represents over a third of all the mental health trusts in England. We have produced a ReQoL case study highlighting implementation in one of the early implementer trusts.


To support national implementation, the ReQoL website has been updated and has links to a range of supporting materials including:

• A brief guide to help people interpret ReQoL score

• A short training presentation which can be adapted for specific trusts and cascaded through teams

• A co-produced information leaflet for service users

Also, translations of ReQoL are now available in Hindi and Kannada, and work is underway to translate ReQoL into other Indian languages. This work is being coordinated by Dr Nilamadhab Kar, Consultant Psychiatrist at Black Country Partnership NHS Foundation Trust and his team in India through Quality of Life Research and Development Foundation