Table 5.
General strategies for implementing PROMs/PREMs in routine care (derived from Normalization Process Theory [NPT] [45, 46])
| Core constructs from NPT [45, 46], adapted for PROMs/PREMs implementation | 1. Coherence: Assess understanding of PROMs/PREMs in context What are PROMs/PREMs, and why should clinical teams use them? |
2. Cognitive participation: Engage stakeholders in communities of practice Who will do what for routine use of PROMs/PREMs in clinical care? |
3. Collective action: Identify barriers and facilitators What helps or hinders the use of PROMs/PREMs in clinical care? Whom do these factors affect? |
4. Reflexive monitoring: Evaluate understanding of routine PROMs/PREMs use What did we learn about using PROMs/PREMs in clinic? Will we keep doing it? |
|---|---|---|---|---|
| Overlap with relevant domains from widely used implementation science frameworks |
KTA: Identify problem, Select and Review Knowledge i-PARIHS: Innovation (how it is perceived by various stakeholders), Recipient CFIR: Intervention characteristics (e.g., evidence strength and quality, relative advantage, adaptability, complexity), Characteristcs of individuals (e.g., knowledge and beliefs about the intervention) TDF: Knowledge, beliefs and capabilities, social/professional role and identity, beliefs about consequences RE-AIM: Effectiveness (longer-term impacts e.g., quality of life) Proctor’s outcomes: Appropriateness, Cost, Feasibility (stakeholder perceptions) |
KTA: Adapt knowledge to local context (involve local stakeholders) i-PARIHS: Recipient (identify key stakeholders including patients), Facilitation (regular meetings with clinic) CFIR: Leadership engagement (under Inner setting), Process (e.g., engaging, opinion leaders, internal implementation leaders, champions, external change agents) TDF: Skills, memory, attention and decision, emotion, behavioral regulation, intentions, goals, optimism RE-AIM: Reach, Adoption (numbers of patients and champions willing to participate in implementation) Proctor’s outcomes: Acceptability, Adoption, Penetration |
KTA: Assess barriers to knowledge use i-PARIHS: Innovation (how it is adapted to work in local contexts), Context (inner setting and outer setting) CFIR: Outer setting (e.g., patient needs and resources, external policies and incentives), Inner setting (e.g., networks and communication, culture, relative priority, organizational incentives, available resources, access to knowledge and information) TDF: Reinforcement, environmental context and resources, social influences RE-AIM: Maintenance (normalized 6 months after introduction) Proctor’s outcomes: Feasibility, Cost |
KTA: Monitor knowledge use, Evaluate outcomes i-PARIHS: Facilitation, Organizational Readiness to Change assessment CFIR: Reflecting and evaluating (under Process) RE-AIM: Implementation (fidelity) Proctor’s outcomes: Sustainability |
| Implementation strategies identified in case studies |
• Stakeholder engagement • Provide evidence about clinical validity of PROMs/PREMs |
• Training workshops • Workflow redesign • Implementation support team |
• Context assessments • Technology support • Practice facilitator |
• Annual evaluation meetings with clinics • Audit and feedback |
PROM electronic patient-reported outcome measure, PREM electronic patient-reported experience measure, CFIR consolidated framework for implementation research, i-PARIHS integrated framework for promoting action on research implementation in health services, KTA knowledge to action, TDF theoretical domains framework, NPT normalization process theory, RE-AIM Reach effectiveness, adoption, implementation, maintenance framework