Harmonization of patient-reported outcome measurement across four academic medical centers: Multi-site clinician focus group results from the Carolinas Collaborative Initiative.

Abstract

336 Background: Use of patient-reported outcomes (PROs) to monitor symptoms in cancer care demonstrates clinical benefit, but implementation of PROs across healthcare settings remains low. We conducted focus groups (FGs) with stakeholders from four academic medical centers (AMCs) to identify perceived barriers and facilitators to implementing PROs in routine care. Methods: Stakeholders were recruited to participate in FGs and asked to identify barriers and facilitators of future PRO implementation in their respective healthcare setting. Transcripts were coded and synthesized via thematic content analysis. Results: Seventy stakeholders participated in one of 14 FGs (leadership groups, n = 5; nurse groups, n = 4; physician groups, n = 5) stratified by role and site. The mean FG size was 5 (range = 2 to 14). Three overarching domains were identified: Workflow, Training and Implementation, and Data-Driven Action. Table 1 shows the relative frequency of notable codes associated with each domain across FGs aggregated by stakeholder role. Themes within each domain are: Workflow: current workflow dynamics inhibit PRO implementation (code = Workflow, Table 1); more resources are necessary to adjust clinical workflow and the EMR to facilitate administration and clinicians’ ability to respond to concerning symptoms (code = Resources needed, Table 1). Training and Implementation: clinicians may be unaware of the utility of PROs; training about the clinical relevance of PROs may help facilitate integration (code = Training needs, Table 1). Data-Driven Action: data derived from PROs must be interpretable and actionable to promote sustained utility (code = How to display PROs, Table 1). Tailored measures for specific clinical populations are needed, along with information on clinically significant scores, meaningful change thresholds, predictive value, and whether integration of PROs improves healthcare quality. Conclusions: Similar barriers to PRO implementation were identified across four AMCs. Infrastructure is needed in each AMC to help clinics integrate PROs. Resources to address workflow inefficiencies, EMR integration, clinician training, and follow-up support may help facilitate integration. Academic medical centers must also ensure that data derived from PROs are relevant and actionable.[Table: see text]