“Unspoken Questions”: A Qualitative Study of Rheumatologists’ Perspectives on the Clinical Implementation of Patient-reported Outcome Measures

Objective To identify rheumatologists’ views on perceived barriers and facilitators to the clinical implementation of patient-reported outcome measures (PROM). Methods Semistructured interviews were conducted with academically affiliated clinical rheumatologists. Interviews were audio-recorded and transcribed. Deidentified transcripts were independently coded and analyzed for themes. Results Fifteen attending rheumatologists, 8 women (53%) and 7 men (47%) with a mean of 17.3 years in practice (range 5–43) at 2 urban academic medical centers, participated in interviews. Rheumatologists identified several barriers to integrating PROM in clinical care, highlighting physician buy-in and culture change as significant challenges beyond logistical considerations. They further underscored the lack of effective interventions and resources for addressing the domains of most interest to patients. Physicians also recognized significant benefits of PROM in clinical care, including contributing to the clinical impression by providing the patient perspective, and promoting agenda setting by uncovering “unspoken questions.” They additionally noted that PROM could support treatment planning, build patient-physician relationships, and facilitate patient engagement. Participants suggested that technology, physician education, and team-based care could facilitate the effective implementation of PROM. Conclusion Rheumatologists identified multiple mechanisms through which PROM could augment clinical care, but also noted several obstacles to implementation, questioning the added value of PROM and the limited availability of interventions to improve patient-centered outcomes. Programs seeking to successfully integrate PROM to enhance patient-centered care and meet quality benchmarks should prioritize physician buy-in and training, and provide resources to address the outcomes that are measured.

[1]  P. Borzi,et al.  Centers for Medicare and Medicaid Services , 2020, Definitions.

[2]  A. Orbai,et al.  Patient-reported outcomes in RA care improve patient communication, decision-making, satisfaction and confidence: qualitative results. , 2019, Rheumatology.

[3]  E. Alessandrini,et al.  Systemwide Implementation of Patient-Reported Outcomes in Routine Clinical Care at a Children's Hospital. , 2018, Joint Commission journal on quality and patient safety.

[4]  L. Mandl,et al.  Feasibility of Patient-Reported Outcomes Measurement Information System (PROMIS®) computerized adaptive tests in systemic lupus erythematosus outpatients , 2018, Lupus.

[5]  M. O. Papuga,et al.  Large-scale clinical implementation of PROMIS computer adaptive testing with direct incorporation into the electronic medical record , 2018, Health systems.

[6]  K. Liao,et al.  Rheumatology Informatics System for Effectiveness: A National Informatics‐Enabled Registry for Quality Improvement , 2016, Arthritis care & research.

[7]  Deborah Schrag,et al.  Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  M. Genovese,et al.  Development of the American College of Rheumatology's Rheumatoid Arthritis Electronic Clinical Quality Measures , 2016, Arthritis care & research.

[9]  L. Callahan.  The History of Patient-Reported Outcomes in Rheumatology. , 2016, Rheumatic diseases clinics of North America.

[10]  D. Lavallee,et al.  Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care. , 2016, Health affairs.

[11]  D. Howell,et al.  Patient-reported outcomes in routine cancer clinical practice: a scoping review of use, impact on health outcomes, and implementation factors. , 2015, Annals of oncology : official journal of the European Society for Medical Oncology.

[12]  David Feeny,et al.  Training clinicians in how to use patient-reported outcome measures in routine clinical practice , 2015, Quality of Life Research.

[13]  Roma Maguire,et al.  What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  J. Browne,et al.  The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research , 2014, BMJ quality & safety.

[15]  P. Katz.  Introduction to special issue: Patient outcomes in rheumatology, 2011 , 2011, Arthritis care & research.

[16]  Bret R. Shaw,et al.  Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes , 2010, Medical decision making : an international journal of the Society for Medical Decision Making.

[17]  N. Aaronson,et al.  Use of patient-reported outcomes in clinical practice , 2009, The Lancet.

[18]  J. Greenhalgh.  The applications of PROs in clinical practice: what are they, do they work, and why? , 2009, Quality of Life Research.

[19]  Kathleen N. Lohr,et al.  Using patient-reported outcomes in clinical practice: challenges and opportunities , 2009, Quality of Life Research.

[20]  Matthias Rose,et al.  Logistics of collecting patient-reported outcomes (PROs) in clinical practice: an overview and practical examples , 2009, Quality of Life Research.

[21]  R. Hays,et al.  Prospects and challenges in using patient-reported outcomes in clinical practice , 2008, Quality of Life Research.

[22]  G. Guyatt,et al.  The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature , 2008, Quality of Life Research.

[23]  K. Devers,et al.  Qualitative data analysis for health services research: developing taxonomy, themes, and theory. , 2007, Health services research.

[24]  Galina Velikova,et al.  Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  T. Pincus.  Why should rheumatologists collect patient self-report questionnaires in routine rheumatologic care? , 1995, Rheumatic Disease Clinics of North America.

[26]  Anton J. Kuzel,et al.  Sampling in qualitative inquiry. , 1992 .

[27]  F. Wolfe,et al.  Standard self-report questionnaires in routine clinical and research practice--an opportunity for patients and rheumatologists. , 1991, The Journal of rheumatology.