JMIR Publications

ABSTRACT

Background:

While the amount of Patient Reported Outcome Measures (PROMs) collected in hospitals continues to grow, clinicians' use of this data remains suboptimal. Insights into enhancing clinicians' use of PROMs data are crucial, yet currently limited. We examine the efforts and experiences of central change facilitators and clinicians in a Dutch university hospital where, on average around 2023, clinicians accessed PROMs data for only 3 out of 20 patients during their outpatient consultation, despite numerous interventions to improve this.

Objective:

First, we examine the interventions implemented by central change facilitators in the hospital aimed at enhancing clinicians’ outpatient use of electronic PROMs between 2020-2023, and their underlying rationales. Second, we explore the implementation outcomes achieved around 2023, in terms of clinicians’ adoption, implementation, and maintenance of PROMs use. As underuse remains a challenge, we then investigate the key factors driving and constraining clinicians’ use of PROMs in 2023. Last, we identify any missing interventions, highlighting barriers that remain unaddressed or facilitators not leveraged.

Methods:

This mixed-methods study draws upon four data sources: internal hospital documents from a central program team (n= 56), interviews with central change facilitators (n=20), a survey among clinicians (n=47), and one-year performance data on clinicians PROMs’ use (n=70 subdepartments). We use two implementation frameworks: the Iowa Implementation for Sustainability Framework (IISF) to analyze interventions and the RE-AIM framework to examine the outcomes of adoption, implementation, and maintenance.

Results:

The hospital implemented interventions across all ten domains of the IISF. However, there are shortcomings in the quality of execution and completeness of interventions to address all barriers and leverage facilitators. We identify variations in these factors among frequent PROM users, occasional users, and non-users. Challenges to effective intervention are apparent, with certain desired interventions being infeasible or impeded. As a possible result, limitations persist in clinicians' use of PROMs, affecting all three outcomes of adoption, implementation, and maintenance.

Conclusions:

Hospitals should prioritize interventions aimed at achieving and sustaining clinicians' use of PROMs, striving to effectively address the inherent complexities of this endeavor. Concerted and tailored interventions, designed to address within-group differences in clinicians’ needs and motivation, hold promise for future efforts and could also facilitate the successful implementation of other e-health initiatives.