Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1103-D McGavran-Greenberg Hall, CB # 7411, Chapel Hill, NC, 27599, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Qual Life Res. 2021 Nov;30(11):3015-3033. doi: 10.1007/s11136-020-02564-9. Epub 2020 Jul 10.
Patient-reported outcome and experience measures (PROMs/PREMs) are well established in research for many health conditions, but barriers persist for implementing them in routine care. Implementation science (IS) offers a potential way forward, but its application has been limited for PROMs/PREMs.
We compare similarities and differences for widely used IS frameworks and their applicability for implementing PROMs/PREMs through case studies. Three case studies implemented PROMs: (1) pain clinics in Canada; (2) oncology clinics in Australia; and (3) pediatric/adult clinics for chronic conditions in the Netherlands. The fourth case study is planning PREMs implementation in Canadian primary care clinics. We compare case studies on barriers, enablers, implementation strategies, and evaluation.
Case studies used IS frameworks to systematize barriers, to develop implementation strategies for clinics, and to evaluate implementation effectiveness. Across case studies, consistent PROM/PREM implementation barriers were technology, uncertainty about how or why to use PROMs/PREMs, and competing demands from established clinical workflows. Enabling factors in clinics were context specific. Implementation support strategies changed during pre-implementation, implementation, and post-implementation stages. Evaluation approaches were inconsistent across case studies, and thus, we present example evaluation metrics specific to PROMs/PREMs.
Multilevel IS frameworks are necessary for PROM/PREM implementation given the complexity. In cross-study comparisons, barriers to PROM/PREM implementation were consistent across patient populations and care settings, but enablers were context specific, suggesting the need for tailored implementation strategies based on clinic resources. Theoretically guided studies are needed to clarify how, why, and in what circumstances IS principles lead to successful PROM/PREM integration and sustainability.
患者报告的结果和体验测量（PROMs/PREMs）在许多健康状况的研究中已经得到充分确立，但在常规护理中实施这些测量仍存在障碍。实施科学（IS）提供了一种潜在的前进方法，但它在 PROMs/PREMs 中的应用受到限制。
我们通过案例研究比较了广泛使用的 IS 框架的相似点和不同点及其在实施 PROMs/PREMs 中的适用性。三个案例研究实施了 PROMs：（1）加拿大的疼痛诊所；（2）澳大利亚的肿瘤诊所；（3）荷兰的慢性疾病儿科/成人诊所。第四个案例研究正在规划加拿大初级保健诊所的 PREMs 实施。我们比较了案例研究中的障碍、促进因素、实施策略和评估。
案例研究使用 IS 框架系统地分析了障碍，为诊所制定了实施策略，并评估了实施效果。在所有案例研究中，PROM/PREM 实施的一致障碍是技术、对如何或为何使用 PROMs/PREMs 的不确定性以及来自既定临床工作流程的竞争需求。诊所中的促进因素是具体情况具体分析的。在实施前、实施中和实施后阶段，实施支持策略发生了变化。案例研究之间的评估方法不一致，因此，我们提供了特定于 PROMs/PREMs 的示例评估指标。
鉴于复杂性，多层面的 IS 框架对于 PROM/PREM 的实施是必要的。在跨研究比较中，患者人群和护理环境中的 PROM/PREM 实施障碍是一致的，但促进因素是具体情况具体分析的，这表明需要根据诊所资源制定量身定制的实施策略。需要进行理论指导的研究，以阐明 IS 原则如何、为何以及在何种情况下导致 PROM/PREM 的成功整合和可持续性。
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