Patient Reported Outcome Measures in clinical practice: From implementation to optimization

This thesis focusses on the optimization of using Patient Reported Outcome Measures (PROMs) on the individual patient level in clinical practice. The KLIK PROM portal (www.hetklikt.nu) is a tool that facilitates the use of PROMs in daily clinical practice for over 10 years. However, over the years it became clear that implementation of PROMs is an ongoing challenge. In the literature, as well as based on implementation experience, several barriers have been identified on multiple levels. The aim of this thesis is to overcome the identified barriers by 1) gaining insight into stakeholders’ perspective on PROM use in clinical practice, 2) optimizing PROM use in clinical practice.
1) Part 1 showed that clinicians and patients/parents are generally satisfied with using PROMs in clinical practice. However, several barriers were mentioned: burdensome PROMs, low response rate of patients/parents, no discussion of PROMs by clinician, and not daring to start the discussion about PROMs.
2) Part 2 described several improvements that were performed to optimize PROM use:
- Dashboard improvement: optimizing PROM visualization in the KLIK dashboard.
- PROM improvement: making Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CATs) available in the KLIK PROM portal for use in research and clinical practice.
- Patient/parent empowerment: developing online tools to support patients/parents in discussing PROs during consultation.
The way PROMs are implemented in clinical practice is of utmost importance for optimal use. Therefore, a continuous improvement cycle is necessary where evaluations with users are performed and subsequent adjustments are made by working together with important stakeholders such as clinicians, patients, PROM experts and IT experts.