A Realist Evaluation of the Implementation and Use of Patient-Reported Outcomes in Four Value-Based Healthcare...

Area of Science:

• Health Services Research
• Value-Based Healthcare
• Patient-Reported Outcome Measures

Background:

• Limited evidence exists on the effectiveness of Patient-Reported Outcome Measures (PROMs) within diverse routine healthcare settings.
• Understanding the contextual factors influencing PROM implementation in Value-Based Healthcare (VBHC) is crucial for optimizing patient care.

Purpose of the Study:

• To investigate the mechanisms, contexts, and beneficiaries of Patient-Reported Outcome Measures (PROMs) in four distinct Value-Based Healthcare (VBHC) programs.
• To identify factors that contribute to the successful or unsuccessful implementation of PROMs in routine clinical practice.

Main Methods:

• A realist evaluation methodology was employed to explore 'what works, for whom, in what contexts, and why'.
• Data were collected through a scoping review, documentary analysis, questionnaires, routinely collected quantitative data, and semi-structured interviews with patients, carers, and staff across Heart Failure, Parkinson's Disease, Epilepsy, and Cataract surgery programs.
• Programme theories and logic models were developed, tested, and refined throughout the evaluation period (July 2022-August 2023).

Main Results:

• PROMs facilitated improved triage, treatment tailoring, and prioritization of care in Heart Failure and Epilepsy programs, leading to more efficient resource use and better symptom management in Heart Failure.
• Implementation challenges, including lack of IT integration, increased workload, staff resistance, and inconsistent data utilization, hindered PROM effectiveness in Cataract surgery and Parkinson's Disease programs.
• Access to specialist mental health services remained a barrier for Epilepsy patients despite PROM identification of needs.

Conclusions:

• The universal benefit of PROMs in VBHC contexts is challenged; their effectiveness is highly dependent on system support, integration, and adaptation.
• PROMs are often ill-suited for long-term routine care without significant adaptation and require greater staff and patient involvement for enhanced acceptability and relevance.
• Successful implementation necessitates realistic strategies, robust digital infrastructure, clear leadership, and co-designed patient-facing tools to improve engagement and accessibility.