Meerhoff G.1,2, van Dulmen S.1, Nijhuis-van der Sanden R.1, van der Wees P.1
1Radboud UMC, IQ Healthcare, Nijmegen, Netherlands, 2Royal Dutch Society for Physical Therapy (KNGF), Quality, Amersfoort, Netherlands
Background: Outcome measures such as Patient Reported Outcome Measures (PROMs) have great potential in enhancing healthcare quality, both at clinical and aggregated level. At clinical level PROMs can be used for shared decision-making, goal-setting, monitoring outcomes. Aggregated across patients PROMs can be used to increase transparency of treatment outcomes. Such aggregated outcomes provide information for quality improvement and can be used by patients to choose healthcare providers. Despite this potential research showed that PROMs have not been widely adopted yet, so it is unclear if PROMs can fulfil their potential role in physical therapist (PT) practice.
Purpose: Obtaining insight in the barriers and facilitators to the implementation of PROMs in Dutch PT practice based on self-reported and actual PROM use.
Methods: This prospective observational cohort study is part of the development of an innovative national quality program of the Royal Dutch Society for Physical Therapy titled Quality in Motion. For this development data was acquired by 446 PTs during four pilots in the period 2013-2015. The acquired data existed of 1) a self-reported questionnaire, examining the estimated PROM use and 2) the actual PROM use of the participating PTs in clinical practice. This actual PROM use could be determined because all gathered PROMs data from the Electronic Health Record (EHR) systems of the participating PTs was uploaded to a registry that was established within the program.
A multivariate logistic regression model was estimated to identify the barriers and facilitators to self-reported PROM use. The consistency of this model was verified using actual PROM use as independent variable in a secondary multivariate linear regression analysis.
Results: Self-reported PROM use was associated with type of EHR system (OR: 2.97; 95% CI: 1.31 to 6.72), knowledge (OR: 7.53; 95% CI: 1.03 to 5.42) and attitudes (OR: 2.36; 95% CI: 2.99 to 18.92) of participating PTs. Actual PROM use was associated with type of EHR system (B: 17.32; 95% CI: 4.84 to 29.80), knowledge (B: 16.93; 95% CI: 9.08 to 24.78) and being a certified practice (B: 16.12; 95% CI: 1.14 to 31.11).
Conclusion(s): To increase PROM use in Dutch PTs it is important to improve the user friendliness of EHR systems regarding the implementation of PROMs in clinical practice and to focus on knowledge of PROMs, which based on the self-reported and actual PROM use both have been identified as barrier or facilitator.
Implications: The further development of the quality program of the Royal Dutch Society for Physical Therapy should focus on increasing the user friendliness of the EHR systems and increasing the knowledge of PTs regarding PROM use. This is expected to positively influence PROM use, which enables us to determine if PROMs are able to fulfil their potential role in clinical PT practice.
Therefore, in this next phase of the development of the Quality in Motion program different implementation strategies are used to increase the Knowledge of PTs towards the use of PROMs. Additionally communication between EHR-system providers and PTs is increased to optimize the user-friendliness of the EHR-systems to facilitate the implementation of PROMs.
Funding acknowledgements: The program was funded by the KNGF, the different participating networks of physical therapists and two health insurance companies.
Topic: Outcome measurement
Ethics approval: Execution of this study is approved by the Medical Ethical Committee of Radboud university medical center (registration #2014/260).
All authors, affiliations and abstracts have been published as submitted.
