Implementation of EQ-5D-5L as a routine outcome measure in Community Outpatient and Specialized Rehabilitation Services

Abstract

Rehabilitation is a person-centred approach that optimizes functioning to reduce impairments in individuals with illness, injury or disability. Patient-reported outcome measures (PROMs) have a role in rehabilitation to inform clinical practice, enhance patient-centered care, support health services programming, direct performance measurement, and contribute to quality improvement. A Canadian provincial health system implemented a Rehabilitation Model of Care that provides a real-world perspective on the adoption of a standardized PROM, the EuroQol EQ-5D-5L, in the community rehabilitation setting. This article will provide an overview of PROMs implementation in the community rehabilitation context, and discuss key facilitators and challenges to implementation within the 18 early adopter sites and with the spread and scale to 152 urban and rural sites. A change management approach, contextualized local coaching and strong leadership support were facilitators in the initial phases of implementation. Adequate resources and infrastructure from technological platforms for electronic data capture and visualization were assets in addition to clinical teams that had existing strong quality improvement cultures to collect PROMS in existing workflows. Challenges to implementation include the clinical relevance of the PROM, difficulty with contextualization to suit diverse clinical and programmatic teams, and the need for further knowledge sharing activities to build readiness for adoption. The implementation of PROMs in community rehabilitation has added value at the clinical (micro), programmatic (meso) and health system level (macro). Clinically, it has promoted the importance of incorporating the patients’ voice into outcome measurement. At the program level, the cultivation of a data informed learning community was fostered as teams make improvements and use data to inform future program growth or service changes. Finally, at the health system level, data visualization promotes transparency and accountability with performance across the province and the standardized use of the EQ-5D-5L provides a consistent language to promote measurement throughout the health system.

A landscape assessment of the use of patient reported outcome measures in research, quality improvement and clinical care across a healthcare organisation

“…The acceptability of the EQ-5D, from the perspectives of both clinicians and patients, is less clear. For some clinicians there is some concern that the EQ-5D lacks specificity and therefore, believe that it may not be applicable to their patients or practice [ 41 ]. While patients with chronic health conditions believe that it is easy to use and measures domains that are meaningful to them, but may not measure all relevant domains such as fatigue and medication side effects [ 42 , 43 ].…”

Acceptability of the routine use and collection of a generic patient reported outcome measure from the perspective of healthcare staff: a qualitative study

“…These results highlighted the contention between the positive attributes of a generic tool that is brief and broadly applicable to all conditions but at the expense of the level of detail often desired by clinicians from both a patient and discipline perspective. Previous research has shown that some clinicians find disease- or discipline-specific PROMs to be more valuable for informing and measuring clinical care outcomes than generic PROMS,[ 36 ] as generic PROMs may lack the specificity required to identify changes in health specific to the type of care provided [ 21 , 29 ]. In particular, the EQ-5D-5L lacked items relating to cognition, communication and diet, important aspects of health for speech pathologists, psychologists and dietitians.…”

The use of EQ-5D-5L as a patient-reported outcome measure in evaluating community rehabilitation services in Alberta, Canada

“…As part of the R-MoC, the EQ-5D-5L was adopted as a generic PROM and gradually implemented across community and outpatient rehabilitation services beginning in 2017. The process for selecting the EQ-5D-5L included stakeholder consultations, literature review, population needs assessment, current and future state reports, and a gap analysis [6]. Additionally, AHS had endorsed the EQ-5D-5L as the generic PROM for use in the healthcare system in 2015, and further embedding the ability to capture the EQ-5D-5L and other PROMs in Connect Care, the provincewide electronic patient medical information system [12].…”