PROMs and PREMs in routine perinatal care: mixed methods evaluation of their implementation into integrated obstetric care networks

Depla, Anne L.; Pluut, Bettine; Lamain-de Ruiter, Marije; Kersten, Anna W.; Evers, Inge M.; Franx, Arie; Bekker, Mireille N.

doi:10.1186/s41687-023-00568-w

Journal of Patient-Reported Outcomes

Table 1 Implementation outcomes and their assessment

From: PROMs and PREMs in routine perinatal care: mixed methods evaluation of their implementation into integrated obstetric care networks

Implementation outcome	Definition	Indicators	Assessment methods
Acceptability	Perception among CP that the PROM/PREM are agreeable, palatable, or satisfactory	Expected relative advantage Expected reporting ease/comprehensible PROM/PREM and IT system	Qualitative^a Observations^b Survey (MIDI 8 and 15; Extra 3)
Adoption	Initial decision to implement the PROM/PREM	Participating hospitals and midwifery practices Representativeness of those clinics; reason to participate	Administrative data Observation
Appropriateness	Perceived fit, relevance, or compatibility of the PROM/PREM for a) midwifery practices, hospitals, CP, pregnant women, and b) their goal to guide personal care and quality improvement	PROM/PREM fit patient (level, language, condition, font size) PROM/PREM fit professional (visualized, easy access, decision support) PROM/PREM fit culture and values (leadership support) PROM/PREM fit goals: helpful to discuss symptoms/improve care	Qualitative Observations Survey (MIDI 9, 12, 26)
Feasibility	Extent to which PROM/PREM can be successfully used or carried out within the OCN, midwifery practice, hospital	IT: technical issues, adaptability to visualize PROM/PREM meaningful Usability for patients (access, timing) Usability for professional (time efficiency; capable; support)	Survey (MIDI 13 and 16; Extra 1) Qualitative Observations
Fidelity	Degree to which PROM/PREM were implemented as described originally	Consistency of administering PROM/PREM Professionals reviewing PROM/PREM results with patients How and why local adaptations (time points, patient groups)	Observations Administrative data
Implementation cost	Cost impact of the effort to implement PROM/PREM	Technology costs Personnel and time	Administrative data Observations; Qualitative
Penetration	Integration of PROM/PREM in OCN, midwifery practices and hospitals	Targeted patient groups Professionals: involved (or knowledge), training attendance	Survey (MIDI 18 and 28; Extra 2) Observations; Qualitative
Sustainability	Extent to which the PROM/PREM are maintained within an OCN, midwifery practice or hospital	Normalization/routinized (carry on; with what?) Stakeholder perceptions	Administrative data Observations; Qualitative

OCN obstetric care network, CP care professional, PROM patient-reported outcome measures, PREM patient-reported experience measures, IT information technology, MIDI Measurement Instrument for Determinants of Innovations
^aQualitative methods: indicators were embedded in coding schemes of all qualitative data (i.e., open-ended survey answers, transcriptions, observation reports, reflection logbook, naturally occurring documents)
^bObservations: performed along a checklist with these indicators while participating in implementation activities (i.e., project team meetings, kick-off sessions, QI sessions and two-weekly reflection logbook)

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