Table 4 Key Implementation Strategies for PROs Uptake in Practice
Strategy | Approach | |
|---|---|---|
Training and Coaching | Induction Process Clinicians & Patients | • Train clinicians in PRO score interpretation, how to integrate in clinical encounter for communication about “what matters most to patient” and use in patient management and devising shared treatment plans (standardized patient modeling in video simulations and in site visits) • Educate patients on how to use PROs in physical symptom and emotional distress self-management and use PROs report for communication with clinicians in clinic visit • Model a person-centred approach for use by clinicians in treatment plans and for engaging patients in taking actions for symptom self-management |
Feedback of Interpretable Reports | • PROs easy to complete/not burdensome to patients (< 10 min to complete) • Complete prior to clinic visit at 1st point of contact to ensure summed report available at clinic visit • Summarized scores in easy to interpret format (patient and clinician) i.e. red flag severe scores with integration in electronic patient record and/or printed for access/use in clinic visit | |
Educational Outreach/Coaching | • Ongoing case-based educational outreach sessions to facilitate use of best practice interventions for managing PRO identified problems; protocols for best practices aligned to scores & clear pathways for referral • Champions respected by peers to encourage uptake in practice; model use in practice/peer learning • Clinician/patient orientation includes standardized training on PROs and ‘how’ to use in communication and for self-management • Integrate PROs in patient self-management guides and patient education pamphlets • Project managers skilled in facilitating practice change | |
Leadership Support & Accountability | Infrastructure and Technology | • Electronic completion available in different languages-data infrastructure at local site • Data infrastructure and designated IT support for timely management of technology problems; tablets accessible to patients at first point-of-contact i.e. blood labs; configure PROs for seamless completion if initial positive screen • Adaptive technology to trigger e-PROs for multidimensional measures if met cut-offs on ESAS-r • Usability field test prior to full implementation |
Engagement of Key Stakeholders | • All stakeholders (clinicians, patients/families, leadership) involved in selection of relevant PROs; and input into “look and feel” of output reports • System mapping by leadership to exploit critical pathways in patient care, resource requirements | |
Governance and Accountability | • Performance accountability for use of PROs in patient management-monitored in QI programs • Alignment of objectives and strategic goals of the organization and daily rapid-cycle improvement priorities • Leadership sets PROs use as a priority performance metric in clinical care (rates of completion) | |
Resources | • Patients have sufficient support to facilitate PROM completion (volunteers, technical assistance) • PROs coordinator with knowledge translation and change management skills for practice uptake | |
Disease Site Ownership | Reconfigure Workflow | • Reconfigure work flow to ensure integration and access to PRO reports at clinical encounter • Patient flow for completion of PROs and normalized as part of clinical care and patient pathways |
Audit and Feedback | • Performance reports designed with stakeholders and feedback to disease site teams for population based QI • Audit and feedback reports emphasize change in scores as a proxy for appropriate intervention • Systems to track progress and identify targets for improvement | |
Team Working | • Team “working” planned and reconfigured to address “what score level” must be addressed and by whom i.e. nurse counselling of patient management of fatigue • Ongoing work in disease site teams to drive optimal use of PROs in care and patient management-institutionalizing the change |