Journal
QUALITY OF LIFE RESEARCH
Volume 30, Issue 11, Pages 3015-3033Publisher
SPRINGER
DOI: 10.1007/s11136-020-02564-9
Keywords
Patient-reported outcome measures; Quality of life; Implementation science; Clinical practice; Routine care
Categories
Funding
- UNC Provost Award [H2245]
- UNC Lineberger's University Cancer Research Fund
- National Institute for Health Research (NIHR) through the Applied Research Collaboration for Oxford
- Thames Valley (ARC OTV) at Oxford Health NHS Foundation Trust
- Gillings School of Global Public Health Nutrition Obesity Research Center (NIDDK) [P30 DK56350]
- Lineberger Comprehensive Cancer Center (NCI) [P30-CA16086]
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Across case studies, consistent barriers to PROM/PREM implementation were identified, including technology issues, uncertainty about how or why to use PROMs/PREMs, and competing demands from established clinical workflows. However, enabling factors were context specific in each clinic, highlighting the need for tailored implementation strategies based on clinic resources. Further theoretically guided studies are needed to explore how IS principles can lead to successful integration and sustainability of PROM/PREMs.
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.
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