gms | German Medical Science

Background and status of research: Patient Reported Outcome Measures (PROMs) have been identified as a central element to strengthen patient centricity. But health systems are at different stages of implementing PROMs, ranging from small pilot projects in a single department to broad implementation health systems. Only a few studies have investigated the successful implementation of PROMs beyond the department or provider-level. Stakeholders currently lack a framework that provides guidance on how to assess, compare and improve PROMs implementation in different countries amid the currently fragmented PROMs landscape.

Question and objective: The research question guiding the study is: How can the maturity of a country's PROMs implementation be assessed and compared with other countries? The aim of this study is to develop a PROMs framework, which facilitates

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the assessment of a health care system's maturity in terms of PROMs implementation and

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the comparison of different countries' PROMs implementation status.

Method or hypothesis: Guided by the grounded theory methodology, a framework was developed and revised in a multi-step process. Based on 28 expert interviews in 12 different countries (AU, CA, CH, DE, DK, EN, IL, NL, NO, SE, US, WS), complementary literature review and an internal and external validation phase, which included 19 additional expert interviews, the framework was continuously refined and validated.

Results: The resulting framework consists of five stages and seven dimensions. The stages of the model range from “early experimentation” to “national adoption and a vibrant ecosystem”. The dimensions are grouped into two categories, PRO-Measurement and PRO-utilization. PRO-Measurement includes the three dimensions “Scope and condition coverage”, “Metric and process standardization”, “Tools and IT solutions”. The PRO-utilization category includes “Patient empowerment and clinical decision support”, “Internal and Public Reporting” and “Rewarding and Contracting”. Both overarching categories are connected via the “Culture and stakeholder involvement” dimension. Advanced countries (NL, WS) showed a concerted implementation approach across the dimensions, whereas other selected countries showed a more uneven approach.

Discussion: The newly developed framework highlights

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the relevance of PROMs integration across medical specialties and care sectors to strengthen patient centric care and

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the importance of coherent progress across the frameworks complementing dimensions, including moving forward not only in the PRO-measurement dimensions but also in terms of PRO-utilization.

Practical implications: For countries to advance PROMs implementation, stakeholder engagement and a strong foundation of facilitating IT infrastructure and standardization is critical when moving to a national adoption. Using PROMs for patient empowerment should not be delayed to later stages of implementation.

Appeal for practice (science and/or care) in one sentence: The framework presents a potential roadmap, which countries like Germany, the country with the lowest overall maturity score among selected countries, can follow to enhance PRO-measurement and utilization.