How to make PROMs work: qualitative insights from leaders at United States hospitals with successful PROMs programs

• Type of Material: Article
• Authors: Colby J Hyland, Harvard Medical School; Danny Mou, Emory University; Azan Z Virji, Harvard Medical School; Claire M Sokas, Beth Israel Deaconess Medical Center; Barbara Bokhour, University of Massachusetts Chan Medical School; Andrea L Pusic, Brigham and Women's Hospital; Christer Mjåset, Harvard T.H. Chan School of Public Health
• Language: English
• Date: 2023-08-01
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
• Final Published Version (URL): http://dx.doi.org/10.1007/s11136-023-03388-z
• Title of Journal or Parent Work: Quality of Life Research
• Volume: 32
• Issue: 8
• Start Page: 2259
• End Page: 2269
• Grant/Funding Information: Dr. Mjåset received a one-year stipend to do healthcare policy research (2019/2020) at the Harvard TH Chan School of Public Health. Harvard T.H. Chan School of Public Health.
• Keywords: Patient-reported outcome measures; Qualitative Research; Humans; Implementation; Delivery of Health Care; Patient Reported Outcome Measures; United States; Clinical PROM program; PROMs; Quality of Life; PROs; Patient-reported outcomes; Primary Health Care; Hospitals
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Purpose: Elucidate facilitators, barriers, and key lessons learned regarding the implementation of system-wide clinical patient-reported outcome measure (PROM) programs among United States (US) healthcare leaders. Methods: We conducted semi-structured interviews with 35 US healthcare leaders, including chief-level executives, data directors, PROM directors, and department chairs involved in PROM implementation across seven diverse healthcare systems from February to June 2020. Transcripts were coded, evaluated for qualitative themes, and categorized according to the consolidated framework for implementation research (CFIR). Results: According to US hospital leaders with experience in existing clinical PROM programs, there are facilitators and barriers to implementation success in each CFIR domain. Allowing clinicians to select PROM measures and ensuring a user-friendly data platform (intervention); adapting data collection to patient home environments (outer setting); informing clinicians of the multi-faceted use of PROM data for research, clinical care, and business (inner setting); implementing PROM education earlier into clinician training (characteristics of individuals); and establishing specialty-agnostic PROM implementation teams (process) were among key facilitators to implementation success. Conclusion: Leaders of geographically and clinically diverse PROM programs in the US identify common themes that facilitate successful implementation. Drivers of success depend on factors within and outside the clinical environment. These findings may serve to guide both establishing new PROM programs and refining existing PROM programs.