Barriers of EQ5D-5L implementation into routine clinical practice: A multisite evaluation.

Abstract

11 Background: As numbers of cancer survivors increase, health-related quality of life and healthcare service utilization warrant closer attention, which requires routine valuations such as health utility scores (e.g. EQ5D-5L). EQ5D-5L implementation into routine clinical practice requires systematic evaluation to assess project scalability with goals of eventual roll-out across all 15 Ontario cancer centres in all disease sites. Methods: We used the Canadian Institutes of Health Research’s Knowledge-to-Action (KTA) framework as a guide to assess implementation of EQ5D-5L in two outpatient cancer populations; St. Michael’s Hospital’s general breast cancer clinic (GBR) and Princess Margaret Cancer Centre’s multidisciplinary brain metastases clinic (MBM), chosen to represent two very different organizational structures and patient populations. KTA steps from landscape assessment and engagement of stakeholders through to pilot implementation using paper surveys are reported. Results: After assessing 270 patients (GBR = 137; MBM = 117) across 57 days, implementation issues at the two sites were noted. GBR clinic’s larger and more general patient base was associated with a lower average socioeconomic status than MBM clinic, which targets a specialized patient population. More barriers to implementation at GBR were systemic and organizational in nature, whereas barriers at MBM were associated with patient management, where patients’ functional disabilities or neglect to return completed questionnaires hindered data collection. For both sites, successful EQ5D-5L implementation was contingent on senior management support and engagement of multiple stakeholders throughout the implementation process, leading to site-specific suggestions. Conclusions: Differing implementation strategies at both sites is reflective of target sites’ distinctive systemic and organizational characteristics and findings can be used to inform the translation of EQ5D-5L to other sites. We present recommendations to aid scalability and implementation efforts, including future transition to electronic routine assessments.