Using Implementation Science to Evaluate the Implementation of Patient-Reported Outcome Measures (PROMs) in a Clinical Heart Failure Care Setting

Abstract

Background

Patients with heart failure (HF) can experience poor quality of life, recurring hospitalizations, and progressive disease symptoms. Patient-reported outcome measures (PROMs) include patients’ voices in clinical care by assessing patient symptoms, function, and quality of life. In 2022, PROMs were implemented into the electronic health record system (Epic) at a large academic hospital in Toronto, Canada. The purpose of this study was to use implementation science frameworks to systematically evaluate the uptake and integration of PROMs into clinical HF care.

Methods

The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided this mixed-methods, 1-year quality-improvement project. Data sources included clinician use of PROMs, patient-level data on completed PROMs, and semistructured interviews with clinicians. The PROM was the Kansas City Cardiomyopathy Questionnaire-12, which captures 4 domains related to HF: symptom frequency, physical limitations, social limitations, and quality of life. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using behaviour-change frameworks and latent content analysis.

Results

Over the course of 1 year, more patients were assigned to PROMs, a higher proportion of patients completed PROMs, and approximately 60% of patients had high questionnaire scores. Clinicians experience barriers related to attention and decision processes, environmental context, and their professional role, in integrating PROMs into practice. Suggested resources include adding language licenses for PROM translations, reducing cognitive load for clinicians assigning and interpreting PROMs in Epic, and champions modelling PROMs in practice.

Conclusions

This study demonstrates the benefit of using implementation science frameworks to evaluate the implementation of PROMs in practice and provide actionable recommendations to health systems.