Prospective application of implementation science theories and frameworks to inform use of PROMs in routine clinical car
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Prospective application of implementation science theories and frameworks to inform use of PROMs in routine clinical care within an integrated pain network Sara Ahmed1,2,3,4,7 · Diana Zidarov3,4,5 · Owis Eilayyan1,2,3 · Regina Visca6,7 Accepted: 3 August 2020 © The Author(s) 2020
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. Keywords Implementation science · Theoretical frameworks · Barriers · Enablers · Patient-reported outcome measures · Chronic pain · Integrated care
* Sara Ahmed [email protected] 1
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Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, Montréal, QC, Canada Center for Outcome Research and Evaluation, Clinical Epidemiology, McGill University Health Center, McGill University, Montréal, QC, Canada Centre de Recherche Interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada
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Institut Universitaire Sur La réadaptation en déficience Physique de Montréal, Centre intégré Universitaire de santé Et de Services Sociaux du Centre-Sud-de-L’Ile-de-Montréal, Montréal, Québec, Canada
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Faculté de Médecine, Université de Montréal, École de réadaptation, Montréal, Canada
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RUISS
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