Planning for patient-reported outcome implementation: Development of decision tools and practical experience across four clinics

Therese A Nelson; Brigitte Anderson; Jiang Bian; Andrew D Boyd; Shirley V Burton; Kristina Davis; Yi Guo; Bhrandon A Harris; Kelly Hynes; Karl M Kochendorfer; David Liebovitz; Kayla Martin; François Modave; John Moses; Nicholas D Soulakis; Donald Weinbrenner; Sonya H White; Nan E Rothrock; Annette L Valenta; Justin B Starren

doi:10.1017/cts.2020.37

Planning for patient-reported outcome implementation: Development of decision tools and practical experience across four clinics

J Clin Transl Sci. 2020 Apr 6;4(6):498-507. doi: 10.1017/cts.2020.37.

Authors

Therese A Nelson¹, Brigitte Anderson², Jiang Bian³, Andrew D Boyd⁴, Shirley V Burton⁴, Kristina Davis⁵, Yi Guo³, Bhrandon A Harris⁴, Kelly Hynes², Karl M Kochendorfer⁴, David Liebovitz¹, Kayla Martin³, François Modave³, John Moses², Nicholas D Soulakis¹, Donald Weinbrenner³, Sonya H White³, Nan E Rothrock¹, Annette L Valenta⁴, Justin B Starren¹

Affiliations

¹ Northwestern University, Chicago, IL, USA.
² University of Chicago, Chicago, IL, USA.
³ University of Florida, Gainesville, FL, USA.
⁴ University of Illinois at Chicago, Chicago, IL, USA.
⁵ Northwestern Medicine, Chicago, IL, USA.

Abstract

Introduction: Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist.

Methods: To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors.

Results: Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders.

Conclusions: Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.

Keywords: Patient reported outcome measures (PROs, PROMs); Patient-Reported Outcomes Measurement Information System (PROMIS); electronic health records (EHRs); implementation science; sociotechnical factors; university health systems and hospitals.

Abstract

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