PROMIS in routine clinical care: a scoping review of implementation and use

The Patient Reported Outcomes Measurement Information System (PROMIS®) is a family of patient-reported outcome measures used in research and clinical practice, but little is known about its use in clinical care. This scoping review identified studies of PROMIS in routine clinical care to understand who is using PROMIS in routine clinical care and how.

We conducted a structured search of published literature in PubMed, Scopus, Embase, and Journal of Patient-Reported Outcomes, and hand-searched conference proceedings from the PROMIS Health Organization, International Society for Quality of Life Research, and HealthMeasures User Conferences. Studies were eligible for inclusion if they described routine use of PROMIS in a clinical setting to inform patient treatment, including studies that described implementation of PROMIS and studies that retroactively analyzed PROMIS scores collected as part of routine care. We coded 13 variables regarding study type, data collection setting, and PROMIS administration methods.

Our search identified 428 studies inclusive of 167 published papers and 261 conference abstracts; of these, 31% described implementing PROMIS into routine clinical care and 69% presented data resulting from use of PROMIS in routine clinical care. These studies were drawn from 77 unique institutions largely within the United States (81%) and among adult populations (59%). Academic medical centers were the most common type of institution (69%) producing 92% of identified studies. Over 20 specialties have used PROMIS in routine clinical care, with many studies from orthopedics (49%), oncology (8%), and rheumatology (6%). The most popular PROMIS domains utilized in this context included physical function, pain interference, depression, anxiety, and fatigue. All modes of administration were well-utilized (computer adaptive tests at 52%, profiles at 45%, static forms at 44%). In 69% of institutions, PROMIS is administered alongside other PROs. PROMIS is often integrated with the electronic health record (44%) and administered in clinic waiting rooms (58%).

Adoption of PROMIS seems most robust in academic medical centers, outpatient settings, and specialties with established cultures of patient-reported outcome collection, such as orthopedics. More outreach is needed to understand how PROMIS functions in smaller clinics that do not publish or present in academic spaces.