Implementability of collecting patient-reported outcome data in stroke unit care - a qualitative study

Lisa Lebherz, Elisa Fraune, Götz Thomalla, Marc Frese, Hannes Appelbohm, David Leander Rimmele, Martin Härter, Levente Kriston, Lisa Lebherz, Elisa Fraune, Götz Thomalla, Marc Frese, Hannes Appelbohm, David Leander Rimmele, Martin Härter, Levente Kriston

Abstract

Background: Patient-reported outcome measures (PROMs) assess patient-relevant effects of medical treatments. We aimed to evaluate the implementation of the International Consortium for Health Outcomes Measurement Standard Set for Stroke (ICHOM-SSS) into routine inpatient care of a stroke unit.

Methods: The ICHOM-SSS was administered in a certified stroke unit during and after inpatient care. Semi-structured interviews with medical staff (n = 5) and patients or their proxies (n = 19) about their experience were audio-recorded and analysed using thematic analyses. Implementation outcomes were chosen in advance and adhered to current standards of implementation science.

Results: Patients perceived the ICHOM-SSS to be relevant and feasible. They reported limited understanding of why the assessment was introduced. The overall acceptance of using PROMs was high. While medical staff, too, perceived the assessment to be appropriate and relevant, their appraisal of feasibility, sustainability, and their acceptance of the implementation were low.

Conclusions: For a sustainable implementation of PROMs in clinical practice, IT resources need to be adapted, medical care needs to be reorganized, and additional clinical resources are required. Future research should investigate benefits of the ICHOM-SSS and a simpler, automated implementation in stroke care.

Trial registration: ClinicalTrials.gov Identifier: NCT03795948 , retrospectively registered on 8 January 2019.

Keywords: Feasibility; Implementation; Patient-reported outcome measures; Qualitative methods; Stroke.

Conflict of interest statement

LL, EF, GT, MF, HA, DLR, MH, and LK have no conflict of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Procedure of the evaluated intervention. The shaded icons denote planned but not realised procedures, see results and discussion. The icons were retrieved from https://icons8.com; EHA = Electronic Health Record, PROM = Patient-reported outcome measure
Fig. 2
Fig. 2
Thematic analysis. We used a mainly deductive framework analysis approach, see Gale et al., (2013) [20]
Fig. 3
Fig. 3
Flow chart of patient and proxy interviews
Fig. 4
Fig. 4
Phase 4 in thematic analysis; schematic model of association between themes and concepts. Arrows indicate expected direction and strength of influence; shades highlight a priori selected outcomes, SOP = standard operating procedure

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