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. 2021 Nov;30(11):3015-3033.
doi: 10.1007/s11136-020-02564-9. Epub 2020 Jul 10.

Using an implementation science approach to implement and evaluate patient-reported outcome measures (PROM) initiatives in routine care settings

Angela M Stover  1   2 , Lotte Haverman  3 , Hedy A van Oers  3 , Joanne Greenhalgh  4 , Caroline M Potter  5 ; ISOQOL PROMs/PREMs in Clinical Practice Implementation Science Work Group
Collaborators, Affiliations

Using an implementation science approach to implement and evaluate patient-reported outcome measures (PROM) initiatives in routine care settings

Angela M Stover et al. Qual Life Res. 2021 Nov.

Abstract

Purpose: Patient-reported outcome and experience measures (PROMs/PREMs) are well established in research for many health conditions, but barriers persist for implementing them in routine care. Implementation science (IS) offers a potential way forward, but its application has been limited for PROMs/PREMs.

Methods: We compare similarities and differences for widely used IS frameworks and their applicability for implementing PROMs/PREMs through case studies. Three case studies implemented PROMs: (1) pain clinics in Canada; (2) oncology clinics in Australia; and (3) pediatric/adult clinics for chronic conditions in the Netherlands. The fourth case study is planning PREMs implementation in Canadian primary care clinics. We compare case studies on barriers, enablers, implementation strategies, and evaluation.

Results: Case studies used IS frameworks to systematize barriers, to develop implementation strategies for clinics, and to evaluate implementation effectiveness. Across case studies, consistent PROM/PREM implementation barriers were technology, uncertainty about how or why to use PROMs/PREMs, and competing demands from established clinical workflows. Enabling factors in clinics were context specific. Implementation support strategies changed during pre-implementation, implementation, and post-implementation stages. Evaluation approaches were inconsistent across case studies, and thus, we present example evaluation metrics specific to PROMs/PREMs.

Conclusion: Multilevel IS frameworks are necessary for PROM/PREM implementation given the complexity. In cross-study comparisons, barriers to PROM/PREM implementation were consistent across patient populations and care settings, but enablers were context specific, suggesting the need for tailored implementation strategies based on clinic resources. Theoretically guided studies are needed to clarify how, why, and in what circumstances IS principles lead to successful PROM/PREM integration and sustainability.

Keywords: Clinical practice; Implementation science; Patient-reported outcome measures; Quality of life; Routine care.

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Conflict of interest statement

Authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Relationships between PROM/PREM implementation strategies, implementation science outcomes, and patient outcomes
Fig. 2
Fig. 2
Four case studies
Fig. 3
Fig. 3
PROM/PREM barriers and enablers in case studies
Fig. 4
Fig. 4
Implementation strategies used in case studies, shown by implementation stage
See this image and copyright information in PMC

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