TY - JOUR
T1 - Using an implementation science approach to implement and evaluate patient-reported outcome measures (PROM) initiatives in routine care settings
AU - Stover, Angela M.
AU - Haverman, Lotte
AU - van Oers, Hedy A.
AU - Greenhalgh, Joanne
AU - Potter, Caroline M.
AU - On behalf of the ISOQOL PROMs/PREMs in Clinical Practice Implementation Science Work Group
AU - Ahmed, Sara
AU - Greenhalgh, Joanne
AU - Gibbons, Elizabeth
AU - Haverman, Lotte
AU - Manalili, Kimberly
AU - Potter, Caroline
AU - Roberts, Natasha
AU - Santana, Maria
AU - Stover, Angela M.
AU - van Oers, Hedy
N1 - Funding Information: Angela M. Stover: Work supported in part by UNC Provost Award H2245, UNC Lineberger’s University Cancer Research Fund, and R25CA171994. The views expressed are those of the authors and not necessarily those of supporting institutions. Caroline M. Potter Receives funding from the National Institute for Health Research (NIHR) through the Applied Research Collaboration for Oxford and the Thames Valley (ARC OTV) at Oxford Health NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. This study made use of resources funded through the Gillings School of Global Public Health Nutrition Obesity Research Center (NIDDK funded; P30 DK56350) and the Lineberger Comprehensive Cancer Center (NCI funded; P30-CA16086): the Communication for Health Applications and Interventions (CHAI) Core. Acknowledgements Funding Information: This paper was reviewed and endorsed by the International Society for Quality of Life Research (ISOQOL) Board of Directors as an ISOQOL publication and does not reflect an endorsement of the ISOQOL membership. Portions of this work were presented at the International Society for Quality of Life research (ISOQOL) conference as workshops (Dublin, Ireland in October, 2018 and San Diego, CA, USA in October, 2019) and as a symposium (Prague, Czech Republic in October 2020). Publisher Copyright: © 2020, The Author(s).
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
KW - Clinical practice
KW - Implementation science
KW - Patient-reported outcome measures
KW - Quality of life
KW - Routine care
UR - http://www.scopus.com/inward/record.url?scp=85087752086&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s11136-020-02564-9
DO - https://doi.org/10.1007/s11136-020-02564-9
M3 - Article
C2 - 32651805
SN - 0962-9343
VL - 30
SP - 3015
EP - 3033
JO - Quality of life research
JF - Quality of life research
IS - 11
ER -