BackgroundPatients with heart failure can experience poor quality of life, recurring hospitalizations, and progressive disease symptoms. Patient-reported outcome measures (PROMs) include patients’ voices in clinical care by assessing patient symptoms, function, and quality of life. In 2022, PROMs were implemented into the electronic health record system (Epic) at a large academic hospital in Toronto, ON. The purpose of this study was to use implementation science frameworks to systematically evaluate the uptake and integration of PROMs into clinical heart failure care. MethodsThe Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided the mixed-methods, one-year quality improvement project. Data sources included clinician use of PROMs, patient-level data on completed PROMs, and semi-structured interviews with clinicians. The PROM was the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) which captures four domains related to heart failure: symptom frequency, physical limitations, social limitations, and quality of life. Quantitative data was analyzed using descriptive statistics and qualitative data was analyzed using behaviour change frameworks and latent content analysis. ResultsOver one year, more patients were assigned to PROMs, a higher proportion of patients completed PROMs, and approximately 80% of patients had high KCCQ-12 scores. Clinicians experience barriers related to attention and decision processes, environmental context, and professional role for integrating PROMs into practice. Suggested resources include adding language licenses for PROMs translations, reducing cognitive load for clinicians assigning and interpreting PROMs in Epic, and champions modelling PROMs in practice. ConclusionsThis study demonstrates the benefit of using implementation science frameworks to evaluate the implementation of PROMs in practice and to provide actionable recommendations to health systems.