The Amsterdam PROM Implementation Strategy: Policy and Pathway

Abstract

Patient-reported outcome measures (PROMs) are an essential tool in practicing value-based health care and patient-centered care. When used in clinical care, PROMs have shown positive effects, including better patient–clinician communication, improved quality of life, and even increased survival. Despite these promising effects, however, real-life implementation of PROMs remains challenging. Therefore, in 2019, the Amsterdam PROM Expertise Center (PEC) was initiated; this multidisciplinary team is dedicated to guiding the implementation of PROMs in the Amsterdam University Medical Centers using an Epic/MyChart electronic health record (EHR). Based on experience and scientific evidence, PEC developed both the PROM policy consisting of eight recommendations and the Amsterdam PROM Pathway, a practical guideline to implement PROMs in clinical care across diverse patient populations. The Amsterdam PROM Pathway consists of four phases (registration, design, preparation, and implementation) involving eight steps. After a clinician identifies the need for PROM use by registering at PEC (Step 0), the health care team will initially conduct a content intake session with PROM experts to identify and choose appropriate patient-reported outcomes and corresponding PROMs and to define a suitable workflow (Step 1). Second, the technical intake occurs with application specialists to establish the workflow within the EHR. In the third and fourth steps, the PROMs are integrated into the EHR, and the construction is rigorously tested. During the fifth step, the entire health care team undergoes comprehensive training in both theoretical knowledge and practical skills, preparing them for the subsequent go-live phase with PROMs in Step 6. Finally, the seventh step involves a short-term and annual evaluation of the implementation process to identify problems that may have arisen and to provide possible solutions. The initiation of PEC and the development of the PROM policy and the Amsterdam PROM Pathway have been instrumental in overcoming hurdles on multiple levels: the hospital, the information and communications technology system, the PROMs, the clinician, and the patient. Improving PROM implementation requires an ongoing process supported by current and future research and implementation projects on, for instance, the optimization of EHR usage and inclusivity of PROMs for all patients. Since launching its Amsterdam PROM Implementation Strategy, the organization has provided PROM-specific training to hundreds of clinicians and has seen health care team PROM engagement grow from 15 when going live in 2019 to 74 in April 2024. In addition, the number of health care teams using one or more Patient-Reported Outcomes Measurement Information System measures in their PROM sets has increased from 0 in 2019 to 26 in April 2024.