Prospective application of implementation science theories and frameworks to inform use of PROMs in routine clinical care within an integrated pain network

Abstract

Purpose The objective of this study is to present the implementation science approaches that were used before implementing electronic patient-reported outcome measures (ePROMs) across an integrated chronic pain network that includes primary, rehabilitation, and hospital-based care. Methods The Theoretical Domains Framework (TDF) was used to identify potential barriers and enablers to the use of ePROMS by primary care clinicians. In rehabilitation and tertiary care, the Consolidated Framework for Implementation (CFIR) was used to guide the identification of determinants of implementations, through observation of workflow, patient and clinician surveys, and clinician interviews. A mixed-method concurrent design comprising a quantitative and qualitative analysis was used. The results were reviewed by a steering committee to iteratively inform the ePROM implementation plan. The Proctor framework of evaluation was used to guide the development of an evaluation plan for the implementation of ePROMs in the integrated chronic pain network. Results Both frameworks provided similar results with respect to healthcare provider knowledge, behaviour, and experience interpreting PROM scores. The TDF and CFIR frameworks differed in identifying organizational-level determinants. The resultant implementation plan was structured around the adoption of PROMs to inform individual treatment planning and quality improvement. The evaluation plan focused on implementation and impact outcomes to evaluate the ePROM intervention. Conclusions The TDF and CFIR guided the development of a multi-component knowledge translation and training intervention that will address multiple gaps and barriers to implementation of PROMs across the integrated network. The ePROM intervention will aim to increase clinicians' knowledge and skills and foster best practices.

Facilitators, barriers and considerations for the implementation of healthcare innovation: A qualitative rapid systematic review

“… % represented the percentage of papers that identified the subtheme as important; a. Addis et al., 2019; b. Ahmed et al., 2020; c. Barnett et al., 2011; d. Conway et al., 2019; e. Ho et al., 2019; f. Katzman et al., 2016; g. Keddem et al., 2020; h. Ross et al., 2018; i. Shrubsole, 2019; j. Srivastava et al., 2020; k. Svensson et al., 2017; l. Vogel et al., 2016; m. Wiecha et al., 2004 ( n = 13). …”

“… % represented the percentage of papers that identified the subtheme as important; a. Ahmed et al., 2020; b. Birkin et al., 2016; c. Bonder et al., 2020; d. Devries et al., 2017; e. Hermes et al., 2019; f. Katzman et al., 2016; g. Keddem et al., 2020; h. Licskai et al., 2012; i. Melo & Bishop, 2020; j. Ross et al., 2018; k. Shrubsole, 2019; l. Svensson et al., 2017; m. Vogel et al., 2016; n. Wolfe et al., 2019; o. Hunter et al., 2020; p. Hunter, Kim, et al., 2020; q. Santiago et al., 2020; r. Srivastava et al., 2020; s. Wiecha et al., 2004; t. Williams et al., 2021; u. Newhouse & White, 2011; v. Puga et al., 2013; w. Ray et al., 2019; x. Walston et al., 2006 ( n = 24). …”

“…First, the importance of sharing information with stakeholders about the innovation prior to implementation is essential. Introducing relevant background information (Addis et al., 2019; Ahmed et al., 2020; Birken et al., 2016; Bonder et al., 2020), as well as evidence of effectiveness (Addis et al., 2019; Barnett et al., 2011; Devries et al., 2017; Keddem et al., 2020; Ross et al., 2018; Williams et al., 2021), and how performance of the innovation will be monitored over time (Srivastava et al., 2020; Vogel et al., 2016; Wiecha et al., 2004) are important to promote stakeholder buy‐in and successful implementation. Information sharing informs the roadmap of how innovations can take shape in the workplace (Morris et al., 2020).…”

Using feedback tools to enhance the quality and experience of care

“…A recent review of implementation in cancer care suggests that reports of real-world PRO implementations are limited [2] and especially connections with, and emphasis on, implementation science frameworks remains limited [3][4][5]. The first set of five papers of the special issue were submitted on behalf of the 'ISOQOL PROMs/PREMs in Clinical Practice Implementation Science Work Group' [4,[6][7][8][9] and describe how implementation science theories and frameworks can guide translation processes from research to practice. The papers are based on a set of case studies describing the use of five well-established implementation science frameworks (for an overview refer to Table 1 in [4]), illustrating how multidisciplinary approaches support implementation in practice settings and increase the likelihood of adoption.…”

Improving the patient-centred care of children with life-altering skin conditions using feedback from electronic patient-reported outcome measures: protocol for a hybrid effectiveness-implementation study (PEDS-ePROM)

“…11 Multi-level influences on implementation can be examined through a focus on individual characteristics of patients, families and clinicians (eg, knowledge and beliefs about the intervention), as well as organisational and process factors (eg, engagement). 12 This paper will report the protocol for a randomised controlled trial and implementation study to test the effectiveness and implementation outcomes of a PROM feedback intervention targeting health-related quality of life, in children with the life-altering skin conditions of burn scars and infantile haemangiomas (termed the PEDS-ePROM study, where PEDS refers to children). The intervention involves the delivery of graphical displays of information from electronic PROMs (ePROMs) in routine consultations to encourage communication about the areas displayed and support clinical decision-making.…”