Description:

Although the use of patient-reported outcome measures (PROMs) in practice is increasing, sometimes healthcare providers (HCPs) face barriers when trying to use PROMs across various clinical settings and interprofessional teams. Implementing PROMs on a wide scale poses significant challenges, as it requires engaging providers and changing their clinical practice (e.g., workflow and roles). This first session provides an overview of Implementation Science (IS) frameworks to guide the workshop and illustrate the intersection between the “user” and “implementation process” domains. Also, we will review key terms/nomenclature and discuss the underlying assumptions that frame this symposium. Finally, examples of the various ways in which PROMs can be adopted in clinical practice (e.g., screening, assessment, monitoring, planning, and evaluating care/treatment) will be discussed.

Objective:

• Provide an overview of the implementation of PROMs by HPCs in clinical practice and the importance of Implementation Science to guide the process.

Speakers:

Angela C. Wolff, PhD RN, School of Nursing at Trinity Western University, British Columbia, Canada

Angela C. Wolff, PhD, RN is an Associate Professor at the Trinity Western University School of Nursing (British Columbia, Canada) where she teaches leadership and research-based courses and conducts research about how healthcare providers successfully integrate people-centered assessment tools into practice. Angela has received numerous grants to support this work including a systematic review about barriers and facilitators for patient-reported outcome measure adoption and knowledge translation for the routine use of quality-of-life assessments in community mental health. Her most recent innovation grant is about incorporating equitable people-centered assessments (in the form of PROMs) into undergraduate nursing education. Her involvement in ISOQOL includes Co-Chair of the Clinical Practice Special Interest Group and leading workshops on preparing clinicians to adopt PROMs. Angela is passionate advancing the professional practice of nurses to provide people-centered equitable healthcare to patients, families, and communities.

Elizabeth J. Austin, PhD MPH, Department of Health Systems and Population Health at the University of Washington, Washington, United States

Elizabeth J. Austin, PhD MPH, is a Senior Research Scientist in the Department of Health Systems and Population Health at the University of Washington. She conducts a variety of evaluative and implementation-focused research that targets patient-provider interactions, addressing the informatics, workflow, organizational elements that can lead to more patient-centered clinical decision-making. She previously served as Co-Chair of the ISOQOL Clinical Practice Special Interest Group and has co-led four national/international workshops on PRO implementation in clinical practice. She has implemented patient-reported outcome measures in surgical, primary care, pediatric, and behavioral health care settings across the U.S and led the development of a toolkit to guide health systems in electronic PRO implementation (epros.becertain.org).

Description:

In session two, the focus is on the specific needs of HCPs to adopt PROMs into practice for both initial and sustained use. Specifically, provided will be a review of the TDF and COM-B model (Capability, Opportunity, Motivation and Behavior) to understand barriers and facilitators to change. This includes defining the factors that are influential when seeking to change HCP behavior. Participants will prioritize the factors that matter most to their context to increase provider adoption of PROMs. This interactive session is foundational to subsequent sessions.

Objectives:

• Describe Implementation Science theory pertinent to changing HCP behavior for the adoption of PROMs in clinical practice.
• Identify key factors of HCP behavior that are applicable to participants’ local context.

Speakers:

Angela C. Wolff, PhD RN, School of Nursing at Trinity Western University, British Columbia, Canada

Angela C. Wolff, PhD, RN is an Associate Professor at the Trinity Western University School of Nursing (British Columbia, Canada) where she teaches leadership and research-based courses and conducts research about how healthcare providers successfully integrate people-centered assessment tools into practice. Angela has received numerous grants to support this work including a systematic review about barriers and facilitators for patient-reported outcome measure adoption and knowledge translation for the routine use of quality-of-life assessments in community mental health. Her most recent innovation grant is about incorporating equitable people-centered assessments (in the form of PROMs) into undergraduate nursing education. Her involvement in ISOQOL includes Co-Chair of the Clinical Practice Special Interest Group and leading workshops on preparing clinicians to adopt PROMs. Angela is passionate advancing the professional practice of nurses to provide people-centered equitable healthcare to patients, families, and communities.

Julia Moore, PhD, The Center for Implementation, Ontario, Canada

Dr. Julia E. Moore is the Executive Director for The Center for Implementation. Dr. Moore has a PhD from Penn State in Human Development, where she was trained as an implementation scientist, researching the best ways to implement evidence-based programs. She has worked on over 100 implementation projects.

Dr. Moore is known internationally for her ability to communicate complex implementation science concepts in clear and practical ways. Dr. Moore developed the online mini-course, Inspiring Change: Creating Impact with Evidence-Based Implementation, which has been completed by over 9000 professionals from around the world.

Dr. Moore is most passionate about supporting professionals on how to use implementation science; she has delivered dozens of workshops to thousands of participants.

Description:

Most often HCPs have little experience with PROMs in their formal education. To use PROMs effectively, the first step for HCPs is to develop the knowledge and skills to use PROMs in routine practice. This session focusses on capabilities, the first component of the COM-B model. Practical knowledge (knowing what PROMs are) is crucial for HCPs to feel confident using them. Many studies show that providers need to understand these measures and how to apply them in practice. They also need procedural knowledge (knowing how to use PROMs) to fit them into their routines. As providers become more familiar with PROMs, they need to develop practical skills (e.g., administering PROMs, scoring and interpreting the results to guide patient care, and integrating PROMs into clinical conversations). This session will explore how knowledge and skills needed can vary for HCPs from various professional backgrounds and in different clinical settings.

Objectives:

• Illustrate the knowledge (capabilities) needed for optimal application of PROMs to meet the specific needs of clients for preventive care (screening), chronic care (monitory symptoms and functions), and population-based care (interventional care such as oncology and surgery).
• Demonstrate the skills (capabilities) HCPs need to (a) collect PROMs data (e.g., fill out the PROMs questionnaire), (b) discuss results with patients, (c) score and interpret PROMs, and (d) incorporate PROMs data into clinical reasoning and shared decision making with patients.

Speakers:

Angela C. Wolff, PhD RN, School of Nursing at Trinity Western University, British Columbia, Canada

Angela C. Wolff, PhD, RN is an Associate Professor at the Trinity Western University School of Nursing (British Columbia, Canada) where she teaches leadership and research-based courses and conducts research about how healthcare providers successfully integrate people-centered assessment tools into practice. Angela has received numerous grants to support this work including a systematic review about barriers and facilitators for patient-reported outcome measure adoption and knowledge translation for the routine use of quality-of-life assessments in community mental health. Her most recent innovation grant is about incorporating equitable people-centered assessments (in the form of PROMs) into undergraduate nursing education. Her involvement in ISOQOL includes Co-Chair of the Clinical Practice Special Interest Group and leading workshops on preparing clinicians to adopt PROMs. Angela is passionate advancing the professional practice of nurses to provide people-centered equitable healthcare to patients, families, and communities.

Liv Marit Valen Schougaard, PhD, AmbuFlex – Centre for Patient-reported Outcomes, Gødstrup Hospital, Denmark

I am a registered nurse and completed my Master of Health Science in 2011 and my PhD in 2020. Since 2011, using PROs in clinical practice has been the focus of my work and research. The main topic of my research is the use of PROs in remote care for patients with chronic and malignant diseases. I have experience with several quantitative research designs, including randomized controlled trials, cohort studies, and cross-sectional studies. I have also been involved in several qualitative research studies.

Description:

Implementation does not happen in a vacuum, and the opportunity component of COM-B considers the local environment factors. In this session, we review known environmental factors that often impede HCP use of PROMs, including organizational operations (infrastructure and logistics), physical resources (e.g., clinic layout), technological resources (e.g., electronic medical records systems), people resources (e.g., clinic support staff). Furthermore, the dynamic interplay between HCPs and their surroundings/practice environment is a key influential factor. To reduce the burden on providers, implementors require foresight to address environmental impacts such as workload, time, workflow, and usability of the PROM(s). Multiple practice examples will be shared of how environmental barriers can be redirected to become environmental support via thoughtful implementation design.

Objectives:

• Illustrate the role local environment plays in facilitating HCP adoption of PROMs.
• Identify opportunities to enhance the local environment, including physical, technological, and human resources.

Speakers:

Elizabeth J. Austin, PhD MPH, Department of Health Systems and Population Health at the University of Washington, Washington, United States

Elizabeth J. Austin, PhD MPH, is a Senior Research Scientist in the Department of Health Systems and Population Health at the University of Washington. She conducts a variety of evaluative and implementation-focused research that targets patient-provider interactions, addressing the informatics, workflow, organizational elements that can lead to more patient-centered clinical decision-making. She previously served as Co-Chair of the ISOQOL Clinical Practice Special Interest Group and has co-led four national/international workshops on PRO implementation in clinical practice. She has implemented patient-reported outcome measures in surgical, primary care, pediatric, and behavioral health care settings across the U.S and led the development of a toolkit to guide health systems in electronic PRO implementation (epros.becertain.org).

Lotte Haverman, PhD, Amsterdam University Medical Center, Netherlands

Dr. Lotte Haverman is a medical psychologist by training and associate professor at Amsterdam UMC, the Netherlands. Her research focuses on identifying barriers and facilitators to the use of Patient-Reported Outcome Measures (PROMs) in clinical practice, across diverse patient groups including children, adults, and parents. Her work involves developing and validating PROMs, as well as implementing optimizing methods for providing feedback to clinicians. One of her recent projects focuses on integrating PROMs into shared decision-making in the clinical setting. Dr. Haverman also serves as director of the Amsterdam PROM Expertise Center and the KLIK PROM portal (www.hetklikt.nu), both dedicated to the real-world implementation of ePROMs.

Selina Limmen, MSc, Amsterdam University Medical Center, Netherlands

Selina holds a master’s degree in pediatric physical therapy. After gaining experience in the field, she began her PhD at Emma Children’s Hospital. Her research focuses on implementing shared decision-making (SDM) using patient-reported outcome measures (PROMs) in pediatric physical therapy. As part of her project, she developed a core set of generic PRO(M)s for this setting, investigated the psychometric properties of these PROMs, conducted research on SDM, and implemented both the core set of PROMs and SDM through the KLIK PROM portal in 12 affiliated pediatric physical therapy practices. She trained over 50 therapists in SDM with the use of PROMs.

Description:

Adoption of PROMs in clinical practice is influenced by providers’ motivation for the change. Motivation, the third component of the COM-B model, is essential an essential ingredient. This session will address the part attitudes and beliefs play in facilitating HCP adoption of PROMs in general and for the specific activities of PROM score interpretation and clinical decision-making. Through practice examples offered by a panel of clinical experts, this session will show the importance of assessing HCP attitudes and beliefs before implementation. Furthermore, we will focus on specific approaches to address motivational barriers for clinical audiences to ensure that the benefits of PROMs outweigh the burdens to both providers and patients. Lastly, this session will explore how perspectives might vary for HCPs of different professional backgrounds and/or in different clinical practice settings.

Objectives:

• Illustrate the motivational aspects (e.g., attitudes and beliefs) required for optimal adoption of PROMs in practice.
• Identify approaches to assess, diagnose, and address motivational barriers for HCPs.

Speakers:

Elizabeth J. Austin, PhD MPH, Department of Health Systems and Population Health at the University of Washington, Washington, United States

Elizabeth J. Austin, PhD MPH, is a Senior Research Scientist in the Department of Health Systems and Population Health at the University of Washington. She conducts a variety of evaluative and implementation-focused research that targets patient-provider interactions, addressing the informatics, workflow, organizational elements that can lead to more patient-centered clinical decision-making. She previously served as Co-Chair of the ISOQOL Clinical Practice Special Interest Group and has co-led four national/international workshops on PRO implementation in clinical practice. She has implemented patient-reported outcome measures in surgical, primary care, pediatric, and behavioral health care settings across the U.S and led the development of a toolkit to guide health systems in electronic PRO implementation (epros.becertain.org).

Natasha Roberts, PhD BN(hons), Royal Brisbane and Women’s Hospital, Queensland, Australia

Natasha Roberts is an early career clinician researcher, she is a senior research fellow in UQCCR, holds a Metro North Clinical Research Fellowship in partnership with UQCCR and is a Conjoint Clinical Research Fellow with the Surgical Treatment and Rehabilitation Service (STARS) in Metro North Health, Australia Natasha has 30 years nursing experience, including training in intensive care, later moving into a role as a specialist cancer nurse. Natasha’s research areas include health services research, health equity, implementation science and quality of life. Natasha attained her Bachelor of Nursing degree in 1994, her Honours degree in 2001 and her PhD in 2021, where she investigated implementation of patient reported outcomes into oncology care.

Lisa Edwards, PhD PT, University of Bradford, United Kingdom

Lisa Edwards, PhD, PT, is an experienced physiotherapist, academic, and researcher specialising in both physical and mental health, with a primary focus on suicide prevention. She teaches undergraduate and postgraduate physiotherapy students and is committed to advancing holistic, patient-centered care. Lisa’s research explores the integration of physical and psychological approaches to rehabilitation to improve mental health outcomes. She has contributed to securing several research grants and actively collaborates with interdisciplinary teams. Passionate about physiotherapy education, Lisa equips future practitioners to provide comprehensive care that addresses both physical and mental health needs.

Patricia Franklin, MD MBA MPH, Northwestern University, Feinberg School of Medicine, Illinois, United States

Patricia Franklin, MD MBA MPH is Professor of Medical Social Sciences, Medicine, and Orthopedics at the Feinberg School of Medicine, Northwestern University. For almost three decades, she has designed and implemented novel methods to translate real world healthcare data to patient-centered care to improve health outcomes. In particular, she designed effective methods to collect patient-reported outcomes (PROs) and social risk data from tens of thousands of patients and integrated these data with clinical data to guide personalized treatment decision tools. A 2018 National Academy of Medicine publication recognized her leadership in the FORCE-TJR national research program (AHRQ P50) as a model learning health system where patient-centered research data informed both new best practices and quality improvement efforts. Much of her research has been with aging adults, including people with knee and hip osteoarthritis and total joint arthroplasty. Dr. Franklin has held diverse leadership roles including medical director of health system quality, director of learning health systems training programs for junior faculty (K12) and trainees (PhD, MD), and principal investigator of multi-site federally funded research studies.

Description:

PROMs have the potential to add great value to patient care, yet they also can perpetuate health disparities if not implemented equitably. Current approaches to evaluating PROM implementation often fail to consider the social and structural determinants of health that may influence PROM use across patient populations and the specific role HCPs play in worsening or lessening those disparities. This session explores how measuring and collecting patient-reported outcomes may reinforce inequities and increase health disparities by hiding or misrepresenting health outcomes of diverse people. By accounting for these individual differences, HCPs can better understand and address health inequities, ensuring more equitable care for all patients.

Objectives:

• Explain how information about social determinants of health can be used to enhance fair and equitable use of PROMs.
• Examine strategies for the routine collection of PROMs to ensure inclusivity and equity.

Speakers:

Elizabeth J. Austin, PhD MPH, Department of Health Systems and Population Health at the University of Washington, Washington, United States

Elizabeth J. Austin, PhD MPH, is a Senior Research Scientist in the Department of Health Systems and Population Health at the University of Washington. She conducts a variety of evaluative and implementation-focused research that targets patient-provider interactions, addressing the informatics, workflow, organizational elements that can lead to more patient-centered clinical decision-making. She previously served as Co-Chair of the ISOQOL Clinical Practice Special Interest Group and has co-led four national/international workshops on PRO implementation in clinical practice. She has implemented patient-reported outcome measures in surgical, primary care, pediatric, and behavioral health care settings across the U.S and led the development of a toolkit to guide health systems in electronic PRO implementation (epros.becertain.org).

Richard Sawatzky, PhD RN, Trinity Western University & Centre for Advancing Health Outcomes, British Columbia, Canada

Dr. Sawatzky is professor in nursing at Trinity Western University, lead of the patient-reported outcomes program at the Centre for Advancing Health Outcomes, and internal advisor at the University of Gothenburg Centre for Person-Centred Care. As a Canada Research Chair since 2011, Dr. Sawatzky aims to advance a new paradigm of equitable people-centred health measurement for measuring diverse perspectives of health and healthcare. His team-based program of research includes: 1) methodological research on patient-reported outcomes measurement, 2) mixed-methods research on quality of life assessments in clinical practice, 3) and knowledge translation on equitable people-centred health measurement (www.healthyqol.com).

Angela Stover, PhD, University of North Carolina at Chapel Hill, North Carolina, United States

Dr. Angela Stover is an Associate Professor in the Department of Health Policy and Management at UNC Chapel Hill in the US. She also co-directs the Implementation Science Methods Unit for UNC’s Clinical and Translational Science Award from NIH. Her research program on patient-reported outcome measures (PROMs) and implementation science has spanned 20 years, including developing PROMs and helping clinics implement PROMs. Dr. Stover teaches courses on PROMs and implementation science in the UNC Gillings School of Global Public Health. Dr. Stover has published more than 60 peer-reviewed articles and her work has been cited more than 7,000 times.

Description:

Facilitating adoption of PROMs often necessitating flexible and tailored strategies to support HCP behavior change. Building on previous sessions, this session will help participants translate known factors that matter most into actionable implementation strategies. Implementation strategies showcased will be based on Implementation Science and current evidence-based practices. A real-world example of tailored strategies for a local setting will be featured. Finally, this session will briefly review approaches to evaluate implementation strategies used in practice, using common evaluation frameworks from Implementation Science.

Objectives:

• Demonstrate how implementation strategies should align with the factors that influence HCP adoption of PROMs in the local setting.
• Identify and tailor evidence-based strategies to provide ongoing support for PROM adoption.
• Review approaches to guide the evaluation of PROM implementation efforts.

Speakers:

Angela C. Wolff, PhD RN, School of Nursing at Trinity Western University, British Columbia, Canada

Angela C. Wolff, PhD, RN is an Associate Professor at the Trinity Western University School of Nursing (British Columbia, Canada) where she teaches leadership and research-based courses and conducts research about how healthcare providers successfully integrate people-centered assessment tools into practice. Angela has received numerous grants to support this work including a systematic review about barriers and facilitators for patient-reported outcome measure adoption and knowledge translation for the routine use of quality-of-life assessments in community mental health. Her most recent innovation grant is about incorporating equitable people-centered assessments (in the form of PROMs) into undergraduate nursing education. Her involvement in ISOQOL includes Co-Chair of the Clinical Practice Special Interest Group and leading workshops on preparing clinicians to adopt PROMs. Angela is passionate advancing the professional practice of nurses to provide people-centered equitable healthcare to patients, families, and communities.

Anouk Groenewegen, MSc, Amsterdam University Medical Center, Netherlands

Anouk is a PhD-candidate at the department of Child and Adolescent Psychiatry & Psychosocial at the Amsterdam UMC, and coordinator of the Amsterdam PROM Expertise Center. With a Master’s in Cognitive and Clinical Neuroscience, her research focuses on optimizing the implementation of Patient Reported Outcome Measures (PROM) in daily clinical care. She investigates healthcare professionals’ experiences with implementing and using PROMs, studies patient preferences for PROM feedback, and examines how PROMs can support Shared Decision Making amongst others. Combining her roles as coordinator and researcher, Anouk aims to enhance patient outcomes and care by bridging research and clinical practice.

Julia Moore, PhD, The Center for Implementation, Ontario, Canada

Dr. Julia E. Moore is the Executive Director for The Center for Implementation. Dr. Moore has a PhD from Penn State in Human Development, where she was trained as an implementation scientist, researching the best ways to implement evidence-based programs. She has worked on over 100 implementation projects.

Dr. Moore is known internationally for her ability to communicate complex implementation science concepts in clear and practical ways. Dr. Moore developed the online mini-course, Inspiring Change: Creating Impact with Evidence-Based Implementation, which has been completed by over 9000 professionals from around the world.

Dr. Moore is most passionate about supporting professionals on how to use implementation science; she has delivered dozens of workshops to thousands of participants.