Enhancing Clinicians' Use of Electronic Patient-Reported Outcome Measures in Outpatient Care:Mixed Methods Study

Background: Despite the increasing use of patient-reported outcome measures (PROMs) for collecting self-reported data amonghospital outpatients, clinicians'use of these data remains suboptimal. Insight into this issue and strategies to enhance the use ofPROMs are critical but limited.Objective: This study aimed to examine clinicians'use of PROM data for value-based outpatient consultations and identifyefforts to enhance their use of PROMs in a Dutch university hospital. First, we aimed to investigate clinicians'use of outpatients'PROM data in 2023, focusing on adoption, implementation, and maintenance. Second, we aimed to develop insights into theorganizational-level strategies implemented to enhance clinicians'use of PROM data from 2020 to 2023. This includedunderstanding the underlying rationales for these strategies and identifying strategies that appeared to be missing to addressbarriers or leverage facilitators. Third, we aimed to explore the key factors driving and constraining clinicians'use of PROMs in2023.Methods: We integrated data from 4 sources: 1-year performance data on clinicians'use of PROMs (n=70 subdepartments),internal hospital documents from a central support team (n=56), a survey among clinicians (n=47), and interviews with individualscontributing to the organizational-level implementation of PROMs (n=20). The Reach, Effectiveness, Adoption, Implementation,and Maintenance framework was used to analyze clinicians'adoption, implementation, and maintenance of PROMs. Strategieswere analyzed using the Expert Recommendations for Implementing Change taxonomy, and results were structured around theconstructs of capability, opportunity, and motivation.Results: On average, around 2023, clinicians accessed PROM data for approximately 3 of 20 (14%) patients during theiroutpatient consultation, despite numerous strategies to improve this practice. We identified issues in adoption, implementation,and maintenance. The hospital's strategies, shaped organically and pragmatically, were related to 27 (37%) out of 73 ExpertRecommendations for Implementing Change strategies. These strategies focused on enhancing clinicians'capability, opportunity,and motivation. We found shortcomings in the quality of execution and completeness of strategies in relation to addressing allbarriers and leveraging facilitators. We identified variations in the factors influencing the use of PROMs among frequent PROMusers, occasional users, and nonusers. Challenges to effective facilitation were apparent, with certain desired strategies beingunfeasible or impeded.Conclusions: Enhancing clinicians'use of PROMs has remained challenging despite various strategies aimed at improvingtheir capability, opportunity, and motivation. The use of PROMs may require more substantial changes than initially expected,necessitating a shift in clinicians'professional attitudes and practices. Hospitals can facilitate rather than manage clinicians'genuine use of PROMs. They must prioritize efforts to engage clinicians with PROMs for value-based outpatient care. Specific attention to their professionalization may be warranted. Tailored strategies, designed to address within-group differences inclinicians'needs and motivation, hold promise for future efforts.