Incorporating Patient-Reported Outcome (PROMs) and Experience Measures (PREMs) in Practice: A Resource Guide about What Clinicians Need

Project Summary

In health care, there is a goal to provide patient-centred care (PCC) as a hallmark of achieving effective, quality health care. What this means is that care focuses on the needs and perspectives of the patient. As such, health care providers are faced with the challenge focus on what matters to the patient during their encounters with the health system.

One problem that needs solving is: how do we assist health care providers to incorporate assessment tools that are patient-centred (also referred to as patient-centered measurement (PCM)), and how can health care providers routinely use this information to inform patients’ care?

 

To address these questions, we studied how providers can interpret and integrate data from patient-centered measurement assessments (experience and outcome tools) into routine clinical care, through a systematic review, provider interviews, and stakeholder review of our findings at a deliberative dialogue forum.

Project Findings

Our project developed a resource guide for and about clinicians that complements other existing resources about PCM implementation. The focus is on the use of PCM to facilitate shared decision-making between providers and patients (as well as caregivers) at the point of care. Specifically, the guide provides information about the needs of clinicians to incorporate PCMs into practice. Also, identified are some strategies to address clinicians’ needs, identify facilitators, and mitigate barriers.

 

How to use the Guide

This Resource Guide complements other existing resources about PCM implementation with a specific focus on the healthcare providers who use the PCM tools.

The guide provides information about the needs of clinicians to incorporate PCMs into practice.

 

This guide could be used in various situations:

  1. Current implementation of PCM to optimize clinician uptake
  2. Planning for implementation of PCM to identify anticipated needs and factors (barriers and facilitators) influencing clinicians
  3. Clinicians seeking to use PCMs in their practice
  4. Patients advocating for the use of PCMs
  5. Educate health professional students about incorporating PCMs into practice
 
 

The information is based on clinicians’ “real world” experiences that can be adapted to the local context. Individuals can determine how to use this information for their own goals and needs based on local/organizational contexts. Also, identified are some strategies to address clinicians’ needs, identify facilitators, and mitigate barriers.

The findings fall under three headings: capability, motivation, and opportunity. Browse the top six aspects below:

  • Knowledge is a key factor that influences clinicians’ behavior to incorporate PCMs into practice
  • General and specific knowledge about PCM within a clinical context/practice area
  • Foundational knowledge about PCMs is necessary to scaffold more specific knowledge and skill development
  • Pattern recognition necessary clinical judgement based on PCM data
  • HCPs need to acquire the “know-how” knowledge to be able to incorporate PCMs into the current workflow
  • The exact procedures to administer the PCMs are necessary, including how to view the results and understand how it informs patient care
  • Personal experiences (providers’ self-confidence and self efficacy)
  • Beliefs about PCMs in practice as clinically relevant, beneficial to patients, and valuable to support clinical decisions for care planning/treatment
  • Burden to patients such having difficulty completing the PCM assessment questions and ensuring PCMs represent what is important to patients
  • Ability or proficiency acquired through training and/or practice

  • Develop clinical competence using PCMs

  • Most important skill acquisition is interpretation of PCMs to understand its clinical significance (e.g., summary scores, item or subscale scores, and score changes) to inform care decisions and planning

  • Interpersonal skills are necessary to administer PCM tools and discuss the results to inform care

  • PCMs can be used in conjunction with other data elicited by clinicians (e.g., health history, physical assessment, test results) to support clinical judgment, opinions, and decisions

  • Interpretation of PCM data/scores can be used to make clinical decisions and review treatment options with patients to tailor their care

  • Resources / material resources necessary for PCM implementation
  • Organizational values that are patient-centred
  • Address the environmental challenges that impact the integration of PCMs by healthcare providers

Publications

Wolff, A.C., Dresselhuis, A., Hejazi, S. et al. Healthcare provider characteristics that influence the implementation of individual-level patient-centered outcome measure (PROM) and patient-reported experience measure (PREM) data across practice settings: a protocol for a mixed methods systematic review with a narrative synthesis. Syst Rev 10, 169 (2021). https://doi.org/10.1186/s13643-021-01725-2

 

“TWU RESEARCHERS ABNER KOONER, LILLIAN LI, AND GABRIELLA COLLINS ADVANCE PATIENT-CENTERED PRACTICES IN CANADIAN HEALTHCARE”

https://www.twu.ca/news-events/news/twu-researchers-abner-kooner-lillian-li-and-gabriella-collins-advance-patient

Presentations

December 2021: Methods Matters Webinar (see below)

October 2021: International Society for Quality of Life (ISOQOL) annual conference, three workshops and one group symposium:

  • Workshop 1 “Using PROMs for Screening, presentation:” Consideration of the Needs of Clinicians to Successfully Implement PROMs Used for Screening Purposes
  • Workshop 2 “How to Integrate PROs in Routine Care using Complexity Theory,” presentation: Complex Interventions and Implementation Science
  • Workshop 3 “PROMs data visualization in the clinical setting: what do clinician’s need to see?,” presentation: What works for clinicians? A Discussion Panel
  • Symposium entitled “Understanding the Needs and Individual Factors Influencing Clinicians’ Behaviour to Integrate PROMs in Daily Practice,” presentation: User’s Guide for Clinicians to Integrate Patient-Reported Outcome Measures into Daily Practice: A Mixed Method Study
 

October 2021: ISOQOL, Calgary, Oral Presentation, Using Qualitative Interviews and Deliberative Dialogue to Triangulate Systematic Review Findings about Clinicians Use of Patient-Reported Outcome Measures (PROMs) in Daily Practice (watch presentation below)

June 2021: University of Sheffield Oral Presentation, Embedding Patient-Report Outcome Measures in the Curriculum: Lessons Learned from Student Physiotherapy Education based on a Mixed Methods Study – download slides

June 2021: PROMs Down Under, two poster presentations (with audio recording)

  • Healthcare Providers’ Experience of Incorporating the Voice of Patients: How to Conduct a Mixed Method Systematic Review of Non-experimental Research Using Nvivo
  • Supporting Clinicians to Modify their Everyday Practice to Integrate Patient-Reported Outcome Measures
 

August 2020: TWU Research and Creativity Symposium, Oral presentation, Using NVivoTM for Data Extraction and Synthesis in Systematic Reviews

October 2020: ISOQOL, Prague, Poster Presentation, Healthcare providers’ implementation of patient-report outcome and experience measures in clinical practice: A mixed method systematic review using an implementation science framework

Subsequent Grants

Developing Clinical Decision Tools and Hosting Educational Events to Disseminate an Evidence‐based Resource Guide for the Sustained Use of Patient‐Centered Measurement Data in Mental Health (2021-2022), MSFHR Reach (15,000). Principal Investigator: Wolff, A.C. Co-investigators: Neptune, A., Yaghoub Zadeh, Z., Musto, L., and Jones, B. (patient partner)

This project is part of the Patient-Centred Measurement Cluster.

Team

Principal Investigator

Dr. Angela Wolff ✉︎

Co-Investigators

Shirin Abadi
Barbara Astle
Duncan Dixon
Lisa Edwards
Deborah Gibson
Samar Hejazi
Fuchsia Howard
Sarah Liva
Lynn Musto
Anthony Neptune
Vanessa Noonan
Nelly D. Oelke
Sheryl Reimer-Kirkham
Kathrin Stoll
Saraswathi Vedam

Collaborators

Andrea Burrows
Colleen Butcher
Angela Louie
Scott McNeil
Seyi (Oluseyi) Oyedele
Marie Tarrant
Michelle Urbina-Beggs
Ivy (Ivyline) Williams
Zohreh Zadeh

Advisor

Annie Smith
Ruby Gidda

Patient Partners

Brenda Jones
Dennis McKintuck Dip Mech Eng
Vikram Bubber
Karen Hodge

Research Staff

Andrea Dresselhuis
Vidhi Thakkar
Rachel Jerome
Alexa Huebner

Trainees

Lillian Li
Gabriella Collins
Abner Kooner
Ranbir Rai
Armajot Deol

Methods Matters Webinar

If you’re in a rush, check out these snack-size highlights:

Duration: 1:44

Duration: 1:09

Duration: 1:46

Watch the full webinar:

Duration: 56:16

ISOQOL Webinar, October 2021