Table 2.

Recommendation for PROs Implementation in HF Clinics Based on Identified Barriers

Barrier	Recommendation
Data collection
Burden	Secure administrative and financial support
	Achieve full engagement of the providers and patients
	Optimize workflow:
	Replace unstructured questioning on functional status with PROs
	Assess PROs before the clinic visit, ideally through online data submission
	Use real‐time scoring of PROs with electronic health record integration with presentation in an interpretable format
	PROs frequency: HF‐specific PROs with every encounter, comprehensive PRO panel at 3‐ to 6‐mo interval
Language and health literacy/cognitive barriers	Use available PRO instrument translations
	Patient proxy or a nurse may be assisting in completing the PROs
Results presentation
	Present PROs trends with time on the x‐axis and the PRO score on the y‐axis, ideally with clear labels along the y‐axis facilitating interpretation of the scores (eg, by New York Heart Association class; symptoms frequency—daily, weekly, monthly, no; health status—very poor, poor, fair, good, excellent)
Ambiguous meaning of scales	Educate providers on PRO interpretation
Summary score vs domain score	Provide summary score with the option to review domain scores
PRO utility and clinical value
Clinical judgment supersedes PRO	Educate providers on PRO nature, utility, and additional value over standard history taking
Actionable PRO data	Educate providers on PRO thresholds for action
	Research demonstrating improved care and outcomes with the use of PROs is needed
PROs selection	Both HF‐specific and generic PROs should be implemented in HF clinics, balanced with careful attention to patient response burden and interpretability
	Prevent repeating the same or similar questions when combining multiple PROs
Intended audience for PROs	Approach all providers that participate in care of HF patients