Facilitators and barriers to implementing electronic patient-reported outcome and experience measures in a health care setting: a systematic review

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Abstract

Objective

This systematic literature review aimed to identify factors that influence the implementation of electronic patient-reported outcome measures (ePROMs) and patient-reported experience measures (ePREMs) in healthcare settings.

Introduction

Improvements in health care through increased patient engagement have gained traction in recent years. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are tools used to improve the quality of care from the patient perspective. The influence of implementing PROMs and PREMs using electronic information systems (ePROMs and ePREMs) is not well understood.

Inclusion criteria

Studies with information related to the implementation of ePROMs and/or ePREMs with a focus on health-related services, irrespective of provider type, were included.

Methods

A literature search of peer-reviewed databases was conducted on the 24th of January 2022 for articles about barriers and facilitators of the implementation of ePROMs/ePREMs in healthcare settings. Two reviewers independently extracted relevant findings from the included studies and performed a descriptive code-based synthesis before collaboratively creating a final consensus set of code categories, which were then mapped to the consolidated framework of implementation research (CFIR). Study quality was appraised using a mixed-methods appraisal tool (MMAT).

Results

24 studies were eligible for inclusion in the screening of 626 nonduplicate studies. Quality assessment using the MMAT revealed that 20/24 studies met at least 60% of the MMAT criteria. Ninety-six code categories were identified and mapped to the constructs across all CFIR domains.

Conclusion

To guide the effective implementation of ePROMs/ePREMs in healthcare settings, factors shown to influence their implementation have been summarised as an implementation checklist for adoption and use by clinicians, organisations, and policymakers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-023-00554-2.

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Most cited references 46

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The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2025)

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

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Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Laura Damschroder, David Aron, Rosalind E Keith … (2009)

Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

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The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

Alessandro Liberati, Douglas G. Altman, Jennifer Tetzlaff … (2009)

Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

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Author and article information

Contributors

Ben G. Glenwright:

ORCID: http://orcid.org/0000-0002-9943-564X

Ben.glenwright@health.qld.gov.au

Journal

Journal ID (nlm-ta): J Patient Rep Outcomes

Journal ID (iso-abbrev): J Patient Rep Outcomes

Title: Journal of Patient-Reported Outcomes

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2509-8020

Publication date (Electronic): 14 February 2023

Publication date PMC-release: 14 February 2023

Publication date Collection: December 2023

Volume: 7

Electronic Location Identifier: 13

Affiliations

[1 ]GRID grid.413210.5, ISNI 0000 0004 4669 2727, Physiotherapy Department, Cairns Hospital, , Cairns Hinterland and Hospital Health Service, ; Orthopaedic Ward, D6, Cairns Hospital, 165 The Esplanade, Cairns, QLD 4870 Australia

[2 ]GRID grid.1003.2, ISNI 0000 0000 9320 7537, School of Health and Rehabilitation Sciences, , University of Queensland, ; Brisbane, Australia

[3 ]GRID grid.1003.2, ISNI 0000 0000 9320 7537, RECOVER Injury Research Centre, , University of Queensland, ; Brisbane, Australia

[4 ]GRID grid.1003.2, ISNI 0000 0000 9320 7537, Centre for Health Services Research, , University of Queensland, ; Brisbane, Australia

[5 ]GRID grid.416100.2, ISNI 0000 0001 0688 4634, Physiotherapy Department, , Royal Brisbane and Women’s Hospital, ; Brisbane, Australia

Author information

Ben G. Glenwright http://orcid.org/0000-0002-9943-564X

Article

Publisher ID: 554

DOI: 10.1186/s41687-023-00554-2

PMC ID: 9928985

PubMed ID: 36786914

SO-VID: 4dca8394-2ae3-4d89-bfc1-2693cd88212d

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 14 August 2022

Date accepted : 26 January 2023

Funding

Funded by: Far North Queensland Hospital Foundation Research Grant

Funded by: Tropical Australian Academic Health Centre Research Fellowship Scheme

Facilitators and barriers to implementing electronic patient-reported outcome and experience measures in a health care setting: a systematic review

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Abstract

Objective

Introduction

Inclusion criteria

Methods

Results

Conclusion

Supplementary Information

Related collections

REPO4EU WP2 Systematic Reviews

Most cited references 46

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

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