Implementing Patient-Reported Measures in Perinatal Care

The PROM/PREM implemented in this project were those proposed in the PCB set: questionnaires at two moments during pregnancy (T1: first trimester, T2: early third trimester) and three postpartum (T3: maternity week, T4: 6 weeks postpartum, T5: 6 months postpartum). The PCB set was developed internationally and subsequently translated to the Dutch setting, both phases involving all stakeholders, including care professionals and patients [18 (link), 29 (link)]. An overview of the PCB set’s patient-reported domains and timeline for completion is provided in Additional file 1: Fig. S1. The set’s PROM/PREM were implemented for two purposes. First, individual-level PROM/PREM were implemented in clinic: reviewing N = 1 scores with patients during a regular care contact after completing a questionnaire. The timeline of collection, workflow, and follow-up services (including scoring and alert values) were organized as described in the national pilot project [30 (link)]. Second, the same PROM/PREM outcomes would be used at group-level in network-broad QI sessions. Despite the complexity of combining these purposes, findings in our pre-implementation research amongst care professionals, patients and other stakeholders in perinatal care suggested both goals could also reinforce each other [8 (link)]. Direct usability in clinical practice could, for instance, motivate care professionals and patients to comply, thereby generating data for group-level use (and vice-versa). Likewise, other previous findings from our pre-implementation analysis and feasibility pilot [8 (link), 28 (link)], were used to design the initial implementation strategy. Important elements for individual-level use included visual alerts to support care professionals in interpreting the answers and offering patients a choice whether their care professional had insight in their individual PREM answers. During the action research project, this initial implementation strategy (Fig. 1) was continuously refined guided by action research principles in iterative cycles of planning and executing implementation activities, data generation, and reflection on these data to refine subsequent activities. These cycles were conducted jointly by researchers and care professionals. The researchers developed the baseline strategy for project organization and education (e.g. identified possible IT-systems, developed an e-learning and kick-off meeting), provided materials and support for its execution (e.g. patient information folder, for working protocol for care professionals), and facilitated data generation for its refinement (e.g. organized focus groups, sent out the survey). The project teams designed and coordinated local implementation (e.g. adapt instruction material to local workflow, chose the IT system that best fitted local needs and resources) and participated in data generation and reflections (e.g. survey results were discussed in project team meetings, participation in focus groups). Three OCN started implementation sequentially to be able to learn from previous experiences, exchanged via the researchers and directly between care professionals from different OCN. After the one-year implementation period, project teams reported their experiences to their OCN and advised future steps in an end-evaluation.Fig. 1

Timeline of implementation and data generation activities. PROM, patient-reported outcome measure. PREM, patient-reported experience measure. QI, quality improvement. OCN, obstetric care network. CP, care professional. VHBC, value-based healthcare