Implementation Of Patient-reported Outcome Measures Research Articles

Development of a framework with tools to support the selection and implementation of patient-reported outcome measures

BackgroundPatient reported outcomes (PROs) provide information on a patient’s health status coming directly from the patient. Measuring PROs with patient reported outcome measures (PROMs) has gained wide interest in clinical practice for individual patient care, as well as in quality improvement, and for providing transparency of outcomes to stakeholders through public reporting. However, current knowledge of selecting and implementing PROMs for these purposes is scattered, and not readily available for clinicians and quality managers in healthcare organizations. The objective of this study is to develop a framework with tools to support the systematic selection, implementation and evaluation of PROs and PROMs in individual patient care, for quality improvement and public reporting.MethodsWe developed the framework in a national project in the Netherlands following a user-centered design. The development process of the framework contained five iterative components: (a) identification of existing tools, (b) identification of user requirements and designing steps for selection and implementation of PROs and PROMs, (c) discussing a prototype of the framework during a national workshop, (d) developing a web version, (e) pre-testing of the framework. A total of 40 users with different perspectives (clinicians, patient representatives, quality managers, purchasers, researchers) have been consulted.ResultsThe final framework is presented as the PROM-cycle that consists of eight steps in four phases: (1) goal setting, (2) selecting PROs and PROMs, (3) developing and testing of quality indicator(s), (4) implementing and evaluating the PROM(s) and indicator(s). Users emphasized that the first step is the key element in which the why, for whom and setting of the PROM has to be defined. This information is decisive for the following steps. For each step the PROM-cycle provides guidance and tools, with instruments, checklists, methods, handbooks, and standards supporting the process.ConclusionWe developed a framework to support the selection and implementation of PROs and PROMs. Each step provides guidance and tools to support the process. The PROM-cycle and its tools are publicly available and can be used by clinicians, quality managers, patient representatives and other experts involved in using PROMS. Through periodic evaluation and updates, tools will be added for national and international use of the PROM-cycle.

Haematologists\u2019 experiences implementing patient reported outcome measures (PROMs) in an outpatient clinic: a qualitative study for applied practice

BackgroundThe patient-doctor relationship is crucial to provide person-centred care, allowing the alleviation of symptom burden caused by disease or treatment. Implementing Patient Reported Outcome Measures (PROMs) is suggested to inform the decision-making process and lead to initiation of care. Yet there are knowledge gaps regarding how meaningful it is to incorporate PROMs in clinical settings. The aim of this study was to investigate haematologists’ experiences when PROMs were implemented in an outpatient setting.MethodsFourteen participant observations, 13 individual interviews and three in-depth interviews were conducted with haematologists, guided by the qualitative methodology Interpretive Description. Analysis was inspired by Habermas’ critical theoretical framework.ResultsThe haematologists included were characterised by dichotomous experiences with PROMs, either resistant to or supporting their implementation.None were observed to elaborate on PROMs during consultations: instead, primary attention was spent discussing the hematological agenda dictated by the system.ConclusionThe use of PROMs for individualized care was linked with extensive uncertainties and PROMs were not requested by the haematologists. To improve individualized care, other approaches may be more suitable. If PROMs are to be incorporated into future clinical practice, they should be tested tothe specific patient group and involve relevant users.

Factors in Randomized Controlled Trials Reported to Impact the Implementation of Patient-Reported Outcome Measures Into Routine Care: Protocol for a Systematic Review.

BackgroundPatient-reported outcome measures (PROMs) are tools that enable patients to directly report their own assessments of well-being, or symptoms, in a structured and consistent way. Despite the usefulness of PROMs in optimizing health outcomes, their use in clinical practice is not routine. PROMs are complex to integrate into the clinical setting, with many elements potentially impacting on the success of implementation. For this reason, a protocol has been developed to guide a systematic review to collate information on implementation as presented in the randomized controlled trials (RCTs) to date.ObjectiveThe primary objective of this systematic review is to identify and synthesize factors available from RCT data about the fidelity of PROM interventions in clinical practice. The secondary objective will be an assessment of how implementation factors impact fidelity outcomes.MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be followed. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature via OvidSP will be accessed using a defined search strategy. Grey literature and ClinicalTrials.gov will be reviewed for unpublished studies. Data extraction will be done to identify fidelity and factors impacting implementation, summarized using a narrative synthesis. An evidence-based implementation science framework will assist in identifying potential elements of importance and their effect on the process and outcomes of implementation. A meta-analysis to assess the impact of implementation factors will be attempted. A Cochrane risk of bias tool will be used.ResultsThis protocol has received funding, and searches of databases will commence at the end of May 2019. It is planned that this systematic review will be finalized for publication in (December) 2019.ConclusionsApplying an implementation science evidence-based framework to the published literature may identify factors present in the data that impact on the implementation of PROMs into routine clinical care. This systematic review aims to improve understanding of how these factors impact the fidelity of this intervention, so that PROMs can be more effectively used in the care of patients. This systematic review can also offer more detailed information about the process and outcomes of successful implementation of PROMs.International Registered Report Identifier (IRRID)PRR1-10.2196/14579

What is needed by staff to implement PROMs into routine oncology care? A qualitative study with the multi-disciplinary team.

The aim of this study was to identify strategies to implement patient-reported outcome measures (PROMs) into routine oncology outpatients' clinical care. Qualitative focus groups were conducted with staff from multiple disciplines using a semistructured interview guide, with supporting data collected in field notes. Data were analysed using a Directed Content Analysis guided by an implementation science framework. The synthesis of the extracted data aimed to identify key requirements which correspond to intrinsic enablers and barriers for implementation. 52 staff members from the multi-disciplinary team participated. Data extracted showed five key themes and three key requirements regarding implementation of PROMs. Staff would consider using PROMs if there was strong research evidence that demonstrates benefits for patient outcomes, if PROM data was relevant to current clinical practice, and if applied appropriately in the specific setting. These findings add pragmatic detail and new knowledge to the current evidence on pathways to PROM implementation. This data can be used to inform implementation of PROMs into health services. Staff have valuable tacit knowledge of what works in practice that offers a unique opportunity to increase successful implementation of a PROM intervention for patient symptom reporting.

A PROM pilot in GI oncology clinic: Outcomes and lessons in real-world implementation.

202 Background: Patient reported outcome measures (PROM) can prolong survival, improve quality of life and reduce ED visits. However, implementation of PROM into practice is challenging. We present the results of a PROM pilot in a tertiary GI oncology clinic. Methods: We recruited a convenience sample of 20 patients undergoing infusional chemotherapy. Patients were English speaking and > 18 years old. We developed a PROM instrument targeting pain, nausea, diarrhea, constipation and fever symptoms in a third party secure online application. Symptoms were scored by frequency and severity on a 5-point Likert scale. The survey was distributed weekly to patients via the patient portal from March to April 2019. Survey results were monitored in real-time. Clinical teams were notified for any symptom score of 4 or 5, increase by 2 or more points between weeks, or self-identified concern. We conducted telephone interviews of non-responders halfway through the pilot to assess reasons for non-response. Results: The mean age was 59 years. Most were female (55%) and self-identified as white (75%). Colorectal (45%) and pancreatic (40%) cancer were the most common cancer types. Most (80%) had metastatic disease and FOLFOX (45%) was the most common regimen. Of the 121 weekly surveys sent, we received 40 responses (33%). Individual response rates ranged from 0% to 100% with a median rate of 25%. Of the 40 responses, 24 (60%) resulted in a clinical trigger. Pain was the most common trigger (n = 15; 63%) followed by self-identified concern (n = 9; 38%). Five triggers resulted in change in management; recommendation of an OTC medication was the most common intervention. There were 6 ED visits or hospitalizations among 5 patients. Of 9 non-responding patients, 4 reported not seeing the e-mail and 3 reported illness as the reason for non-response. All reported continued enthusiasm for the project. Conclusions: Despite known benefits, successful implementation of PROM remains challenging. We found difficulties with automated integration into the electronic medical record and patient response rates. These factors must be addressed to allow a successful PROM program. Despite these limitations, significant enthusiasm remains for the future of PROM.

"I Am Sure That They Use My PROM Data for Something Important." A Qualitative Study About Patients' Experiences From a Hematologic Outpatient Clinic.

Patient-reported outcome measures (PROMs) in clinical practice have the potential to contribute to and support shared decision-making processes by giving voice to patient concerns during consultations. However, the perspectives of patients diagnosed with chronic hematologic cancer on the use of PROMs are unknown. To describe how patients diagnosed with hematologic cancer experience participating in a randomized PROM intervention study, including initial invitation, completion of questionnaires, and outpatient clinic visits. A qualitative conceptual framework guided the study, using Interpretive Description with a focused ethnographic approach to explore patient experiences with PROMs in applied practice. Analysis was inspired by Habermas' social theory of communicative action. The analysis revealed 3 predominant themes of patient experiences: that PROMs were "In the service of a good cause," "The questions are not really spot on," and "PROMs are sometimes used for something," that is, unknown to the patient. The patients' experiences were dominated by the perspective of the healthcare system and by gratitude and imbalanced power relations. During completion of questionnaires, patients struggled to identify with items, and the questionnaires were associated with low content validity. When visiting the outpatient clinic, patients reported that doctors and nurses rarely discussed patients' PROMs. This study contributes knowledge of patient experiences of the integration of PROMs in hematologic outpatient clinical practice. Findings can guide further research and improve future implementation of PROMs.

Patient-reported outcome measures as a new application in the Swedish Renal Registry: health-related quality of life through RAND-36.

BackgroundAlthough patient-reported outcome measures (PROMs) are gaining increased interest in developing health care quality and are a useful tool in person-centered care, their use in routine care is still limited. The aim of this study is to describe the implementation and initial results of PROMs via the Swedish Renal Registry (SRR) on a national level.MethodsAfter testing and piloting the electronic PROM application, nationwide measures were carried out in 2017 for completing the RAND-36 questionnaire online or by paper in a wide range of chronic kidney disease (CKD) patients (Stages 3–5, dialysis and transplantation) through the SRR. Cross-sectional results during the first year were analyzed by descriptive statistics and stratified by treatment modality.ResultsA total of 1378 patients from 26 of 68 renal units (39%) completed the questionnaire. The response rate for all participating hemodialysis units was 38.9%. The CKD patients had an impaired health profile compared with a Swedish general population, especially regarding physical functions and assessed general health (GH). Transplanted patients had the highest scores, whereas patients on dialysis treatment had the lowest scores. The youngest age group assessed their physical function higher and experienced fewer physical limitations and less bodily pain than the other age groups but assessed their GH and vitality (VT) relatively low. The oldest age group demonstrated the lowest health profile but rated their mental health higher than the other age groups. The older the patient, the smaller the difference compared with persons of the same age in the general population.ConclusionsNationwide, routine collection of PROMs is feasible in Sweden. However, greater emphasis is needed on motivating clinical staff to embrace the tool and its possibilities in executing person-centered care. CKD patients demonstrate impaired health-related quality of life, especially regarding limitations related to physical problems, GH and VT/energy/fatigue.

PROMs data: can it be used to make decisions for individual patients? A narrative review.

Patient-reported outcome measures (PROMs) are increasingly used in clinical practice providing health care professionals with patients’ perceptions and views of their health. They have traditionally been utilized in health research and health service evaluation and are now starting to be used in routine clinical practice with individual patients. The repeated administration of PROMs over the course of care with individual patients has a role in patient assessment, assisting clinical decision-making, and tracking patient progress. This approach can influence the patient–clinician encounter impacting the therapeutic alliance and increasing patient engagement with care. It is also theorized to improve patient outcomes and satisfaction with care. Advances in technologies and innovations in methodology have led to the use of electronic systems to simplify the collection and reporting of PROMs. Challenges of using PROMs with individual patients include clinician knowledge and skills, and access to appropriate technology. This paper reviews the use of PROMs with individual patients, illustrating how they may affect the patient–clinician encounter impact satisfaction and health outcomes. The routine use of PROMs during a course of care rather than just at the start and end provides additional opportunity to inform clinician and patient with benefits to both. The adoption of PROMs in clinical practice can help health care professionals to make decisions for individual patients. Further work is needed to examine the implementation of PROMs and benefits of PROMs in different clinical contexts.

Patient-reported outcome measures within pediatric solid organ transplantation: A systematic review.

Subjective evaluation of medical care and disease outcomes from patients' perspectives has become increasingly important. Patient-reported outcome measures (PROMs) play a prominent role in engaging patients, capturing their experiences and improving patient care. This systematic review sought to identify PROMs that are used in the field of pediatric solid organ transplantation, with the aim to inform the implementation of PROMs into clinical practice for this population. A systematic review of English language, peer-reviewed articles was performed on key health science databases to identify publications using PROMs in pediatric solid organ transplantation. The search yielded 3670 articles, with a final data set of 62 articles that included 47 different PROMs. The three most frequently used PROMs included the following: (a) PedsQL™ Generic Core Scales (n=25); (b) Children's Depression Inventory (n=6); and (c) Child Health Questionnaire (n=6). Of the 47 PROMs, 42 were generic and five were disease-specific; only six PROMS had a documented psychometric evaluation within a pediatric solid organ transplant population. This review outlines the attributes of the instruments (eg, domains captured), as well as the psychometric properties of those evaluated. PROMs are increasingly used in the field of pediatric transplantation; however, there are limited details in the current literature about their conceptual underpinnings and psychometric properties. This review highlights the need for additional psychometric evaluation of identified measures to establish the necessary foundation to inform the implementation of PROMs into clinical care for pediatric solid organ transplant patients.

Outcome measurement-a scoping review of the literature and future developments in palliative care clinical practice.

The aim of this scoping review is to give an overview and appraisal of the development of outcome measurement throughout time and its present importance to healthcare and specifically to palliative care clinical practice. It is based on a search and search results of a published systematic review on implementing patient reported outcome measures in palliative care clinical practice. Medline, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Embase and British Nursing Index were systematically searched from 1985. Hand searching of reference lists for all included articles and relevant review articles was performed. A total of 3,863 articles were screened. Sixty were included in this scoping review. Outcome measurement has a long history in health care and some of the strongest advocates were Florence Nightingale for using patient outcomes besides mortality rates, Codman for the "end result idea" of evaluating the patient status one year after orthopaedic surgery, and Donabedian for taking Codman's work further and developing the structure-process-outcome model. The contribution of patient-centred outcome measurement is vast and paramount in education, audit and as an informative tool for healthcare professionals and decision makers. It is possible to collect these data nationwide which would then allow for cross country comparisons, as well as, economic evaluations in palliative care interventions to contribute to appropriate resource allocation.

Implementation of patient-reported outcome measures in appropriateness criteria of surgery for degenerative lumbar scoliosis

BACKGROUND CONTEXTDegenerative lumbar scoliosis (DLS) is an increasingly common spinal disorder of which current management is characterized by a substantial variety in treatment advice. To improve evidence-based clinical decision-making and increase uniformity and transparency of care, the Scoliosis Research Society established appropriateness criteria for surgery for DLS. In these criteria, however, the patient perspective was not formally incorporated. Since patient perspective is an increasingly important consideration in informed decision-making, embedding patient-reported outcome measures (PROMs) in the appropriateness criteria would allow for an objective and transparent patient-centered approach. PURPOSETo evaluate the extent that patient perspective is integrated into the appropriateness criteria of surgery for DLS. STUDY DESIGNSingle center, retrospective, cohort study. PATIENT SAMPLE150 patients with symptomatic degenerative lumbar scoliosis. Outcome MeasuresThe association between appropriateness for surgery and various PROMs [Visual Analogue Scale for pain, Short Form 36 (SF-36), Pain Catastrophizing Scale (PCS), Hospital Anxiety Depression Scale (HADS), and Oswestry Disability Index (ODI)]. METHODSMedical records of all patients with symptomatic DLS were reviewed and scored according to the appropriateness criteria. To assess the association between the appropriateness criteria and the validated PROMs, analysis of variance was used to test for differences in PROMS for each of the three categories resulting from the appropriateness criteria. To assess how well PROMs can discriminate between appropriate and inappropriate, we used a logistic regression analysis. Discriminative ability was subsequently determined by computing the area under the curve (AUC), resulting from the logistic regression analysis. Spearman rank analysis was used to establish a correlation pattern between the PROMs used and the appropriateness criteria. RESULTSThere was a significant association between the appropriateness of surgery and the PROMs. The discriminative ability for appropriateness of surgery for PROMs as a group was strong (AUC of 0.83). However, when considered in isolation, the predictive power of any individual PROMs was poor. The different categories of the appropriateness criteria significantly coincided with the PROMs used. CONCLUSIONThere is a statistically significant association between the appropriateness criteria of surgery for DLS and PROMs. Implementation of PROMs into the appropriateness criteria may lead to more transparent, quantifiable and uniform clinical decision making for DLS.

Usage of glaucoma-specific patient-reported outcome measures (PROMs) in the Singapore context: a qualitative scoping exercise

BackgroundDespite the increasing emphasis on the role of glaucoma-specific patient-reported outcome measures (PROMs) as relevant outcome measures for the impact of glaucoma and its intervention on patients' daily lives, the feasibility of implementing PROMs in the routine clinical setting in Singapore remains undefined. We aim to evaluate the comprehensibility, acceptability, and relevance of four glaucoma-specific PROMs at healthcare professionals' and patients' level in a Singapore context.MethodsSixteen ophthalmic healthcare professionals and 24 glaucoma patients, with average age 60 years (SD = 15), were invited from a tertiary hospital in Singapore. Semi-structured interviews were conducted to explore participants’ perceptions on the content and administration of four glaucoma-specific PROMs - the Glaucoma Quality of Life-15, Glaucoma Symptom Identifier, Independent Mobility Questionnaire and Treatment Satisfaction Survey of Intra-ocular Pressure. Semi-structured interviews were hand transcribed, and analysed thematically. Each participant filled out a feasibility survey at the end of interview.Results79% of glaucoma patients and 94% of glaucoma healthcare professionals felt selected PROMs relevant to patients. 63% of glaucoma patients and 50% of healthcare professionals felt that selected PROMs were sufficiently comprehensive for clinical use. 46% of glaucoma patients and 56% of healthcare professionals felt selected PROMs were user-friendly.ConclusionsUsing PROMs in the Singapore clinical setting receives promising support from both healthcare professionals and patients. The identified potential barriers tailored to Singapore clinical setting will help successful implementation of PROMs into routine clinical care.

Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons

ObjectiveTo gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful...

Using Patient Reported Outcomes Measures to Promote Integrated Care.

Introduction:Patient reported outcome measures (PROMs) have been introduced as standardised outcomes, but have not been implemented widely for disease targeted pathways of care, nor for geriatric patients who prefer functional performance and quality of life.Discussion:We describe innovative multipurpose implementation of PROMs as evidenced by two best practices of PROMs application in geriatric and physiotherapy practice. We show that PROMs can show meaningful outcomes in older subjects’ patient journeys, which can at the same time serve individuals and groups of both patients and professionals.Key lesson:PROMs can deliver generic outcomes relevant for older patients, may improve patient-physician relationship, quality of care and prediction of future outcomes in geriatric care, if they are valid, reliable and responsive, but still short and simple. A precondition to make the hard tip from research to practice is that PROMs are carefully positioned in the clinical encounters and in electronic health records.

The challenges and opportunities of using patient reported outcome measures (PROMs) in clinical practice

From the standpoint of the healthcare provider, multiple contributors to a patients' clinical presentation, difficulty with translating research trials into one's practice, conflicting clinical practice guidelines, and an ever-increasing volume of literature compounds the difficulty for clinicians to determine best care, which addresses the biological, psychological and sociological health domains. If clinicians are adopting a patient centred model of care – routine use of validated patient reported outcome measures (PROMs) which elicit patients' views of their symptoms, their functional status, their health-related quality of life (HRQoL), all of which encompass several domains – are paramount. This commentary advocates for the use of PROMs on a wider scale than is currently described in the literature. Background information on PROMs is provided along with suggesting important questions to ask as a clinician when implementing these in practice. The current commentary addresses these questions and describes the implementation of PROMs using published case studies that describe osteopathy management for a variety of conditions.

HOUT-13. PATIENT REPORTED OUTCOME MEASURES IN BRAIN METASTASES PATIENTS – A SYSTEMATIC REVIEW

Brain metastases (BMs) represent an important health care problem, with increasing incidence rates over time. Due to the heterogeneity of patient and tumor characteristics, it is hard to find consensus on optimal treatment strategy. Especially in palliative care, it is important to measure treatment effects on quality of life (QOL) from the patients’ perspective. Patient reported outcome measures (PROMs) can facilitate optimal treatment choice and even improve outcome in BMs patients. The aim of this review was to systematically analyze implementation and validity of different PROMs in BMs patients. PubMed, Embase, and Cochrane databases were systematically searched for studies on PROMs in patients with BMs. Study selection, data extraction, and quality assessment were performed independently by two investigators. Quality of PRO reporting was determined using the ISOQOL-recommended PRO reporting standards and each questionnaire was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) grading criteria. In total, 53 studies were included, comprising 5358 patients with primary tumor types: lung (61%), breast (16%), gastrointestinal (4%), renal (3%), melanoma (2%), urogenital (2%), other (8%), and unknown (4%). Nine different PROMs were applied, ranging from general cancer (FACT-G, EORTC-QLQ-C15-PAL, ESAS, SF-36, McGill QOL, EuroQol-5D) to brain specific (FACT-Br, BASIQ, EORTC-QLQ-BN20) questionnaires. Half of the general cancer questionnaires (n=3) were not validated among BM patients. According to a predefined cut-off point in line with previous work, 22 studies had insufficient quality of PRO reporting. A variety of PROMs are used in BM patients, including questionnaires intended for general cancer and general patient populations, which have not been validated in patients with BMs. Given the unique clinical considerations in patients with brain metastases, our results indicate the need for a standardized and validated questionnaire with high level of reporting for BM patients.

Framework To Guide The Collection And Use Of Patient-Reported Outcome Measures In The Learning Healthcare System.

Background:Web-based collection of patient-reported outcome measures (PROMs) in clinical practice is expanding rapidly as electronic health records include web portals for patients to report standardized assessments of their symptoms. As the value of PROMs in patient care expands, a framework to guide the implementation planning, collection, and use of PROs to serve multiple goals and stakeholders is needed.Methods:We identified diverse clinical, quality, and research settings where PROMs have been successfully integrated into care and routinely collected and analyzed drivers of successful implementation. Findings are based on key informant interviews with 46 individuals representing 38 organizations, of whom 40 participated in a webinars series, and 25 attended an in-person workshop designed to enable broad stakeholder input, review and refinement of the proposed PROMs implementation model. Stakeholders identified differing uses of PROMs to support: 1) individual patient care decisions, 2) quality improvement initiatives, 3) payer mandates, and 4) population health and research.Results:The implementation framework and steps that are consistently identified by stakeholders as best practices to guide PROM capture and use are described. Of note, participants indicate that web-based informatics tools are necessary but not sufficient for PROM use, suggesting that successful PROM implementation requires integration into clinic operations and careful planning for user’s analytic needs. Each of the four identified uses may require implementation modifications at each step to assure optimal use.Conclusions:The proposed framework will guide future PROM implementation efforts across learning health care systems to assure that complete PROMs are captured at the correct time, and with associated risk factors, to generate meaningful information to serve diverse stakeholders.

Patient-reported outcome measures in urology

Many urologic treatments have similar clinical outcomes, necessitating alternative methods to discriminate between options. Patient-reported outcome measures (PROMs) have become the new standard for evaluating the patient experience, and their use has drastically increased over the past decade. The purpose of this review is to discuss the status of PROMs in urology, highlight commonly used tools and address their future direction. An increasing number of urology-specific PROMs tools have been developed and validated. An increased focus on patient-centered care has provided an impetus for their rise in use. Implementation of PROMs has transitioned from being primarily descriptive in nature to producing actionable findings. Many PROMs are now implemented in daily clinical practice. The future of PROMs will involve new instrument development, integration into clinical practice and the use of PROMs as performance measures. PROMs are effective tools for characterizing symptom burden and health-related quality of life. With increasing clinical implementation, PROMs are playing an increasing role in patients' clinical decision-making.

Identifying barriers to the implementation of patient-reported outcome measures using a theory-based approach

Rationale, aims and objectives: Patient-reported outcome measures (PROMs) are gaining increasing attention within mental healthcare, yet can be difficult to implement into routine practice. To increase uptake, it is recommended to explore the barriers to uptake guided by a theory base, with this information then used to design a tailored improvement strategy. The aim of this study was to explore the barriers to collecting and using a specific PROM within a single setting to inform the design of PROMs promotion strategies.Methods: Staff perceptions of relative advantage and the compatibility with norms and complexity of using the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS) in routine practice were explored through structured group discussions with mental healthcare teams within one Foundation Trust guided by diffusion of innovation theory. Results: Respondents perceived some advantages to using SWEMWBS, notably patient involvement, but also highlighted the burden of paper-based data collection and the poor quality of feedback reports. There was also scepticism regarding the suitability of the tool, particularly for certain groups of patients and concerns regarding use of PROMs for performance management. Views were mixed regarding compatibility with existing norms. Conclusions: To increase uptake, it is recommended that the positive perceptions of relative advantage, compatibility and ease of use identified in this study should be promoted, including through messages delivered by senior staff and tailored educational strategies. Negative (mis)perceptions should be similarly challenged and barriers around paper-based data collection and feedback reports systematically targeted.

A qualitative study of emergency physicians’ perspectives on PROMS in the emergency department

IntroductionThere is a growing emphasis on including patients' perspectives on outcomes as a measure of quality care. To date, this has been challenging in the emergency department (ED) setting. To...