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

Angela M Stover; Lotte Haverman; Hedy A van Oers; Joanne Greenhalgh; Caroline M Potter; ISOQOL PROMs/PREMs in Clinical Practice Implementation Science Work Group

doi:10.1007/s11136-020-02564-9

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

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

Authors

Angela M Stover^{1

2}, Lotte Haverman³, Hedy A van Oers³, Joanne Greenhalgh⁴, Caroline M Potter⁵; ISOQOL PROMs/PREMs in Clinical Practice Implementation Science Work Group

Collaborators

ISOQOL PROMs/PREMs in Clinical Practice Implementation Science Work Group:
Sara Ahmed, Joanne Greenhalgh, Elizabeth Gibbons, Lotte Haverman, Kimberly Manalili, Caroline Potter, Natasha Roberts, Maria Santana, Angela M Stover, Hedy van Oers

Affiliations

¹ Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1103-D McGavran-Greenberg Hall, CB # 7411, Chapel Hill, NC, 27599, USA. stoveram@email.UNC.edu.
² Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA. stoveram@email.UNC.edu.
³ Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁴ School of Sociology and Social Policy, University of Leeds, Leeds, UK.
⁵ Nuffield Department of Population Health, University of Oxford, Oxford, UK.

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.

MeSH terms

Australia
Canada
Humans
Implementation Science*
Patient Reported Outcome Measures*
Quality of Life / psychology

Abstract

MeSH terms

Grants and funding