Abstract：
OBJECTIVE: Patient-report outcome measures (PROMs) have gained widespread support as a mechanism to improve healthcare quality. We aimed to map out key enablers and barriers influencing PROMs implementation strategies in routine clinical practice.
METHODS: An umbrella review was conducted to identify reviews exploring enablers and barriers related to the integration of PROMs in routine clinical practice from January 2000 to June 2023. Information on key enablers and barriers was extracted and summarised thematically according to the Theoretical Domains Framework.
RESULTS: 34 reviews met our criteria for inclusion. Identified reviews highlighted barriers such as limited PROMs awareness among clinicians and patients, perceived low value by clinicians and patients, PROMs that were too complex or difficult for patients to complete, poor usability of PROMs systems, delayed feedback of PROMs data, clinician concerns related to use of PROMs as a performance management tool, patient concerns regarding privacy and security, and resource constraints. Enablers encompassed phased implementation, professional training, stakeholder engagement prior to implementation, clear strategies and goals, \'change champions\' to support PROMs implementation, systems to respond to issues raised by PROMs, and integration into patient pathways. No consensus favoured paper or electronic PROMs, yet offering both options to mitigate digital literacy bias and integrating PROMs into electronic health records emerged as important facilitators.
CONCLUSIONS: The sustainable implementation of PROMs is a complex process that requires multicomponent organisational strategies covering training and guidance, necessary time and resources, roles and responsibilities, and consultation with patients and clinicians.
METHODS: An umbrella review was conducted to identify reviews exploring enablers and barriers related to the integration of PROMs in routine clinical practice from January 2000 to June 2023. Information on key enablers and barriers was extracted and summarised thematically according to the Theoretical Domains Framework.
RESULTS: 34 reviews met our criteria for inclusion. Identified reviews highlighted barriers such as limited PROMs awareness among clinicians and patients, perceived low value by clinicians and patients, PROMs that were too complex or difficult for patients to complete, poor usability of PROMs systems, delayed feedback of PROMs data, clinician concerns related to use of PROMs as a performance management tool, patient concerns regarding privacy and security, and resource constraints. Enablers encompassed phased implementation, professional training, stakeholder engagement prior to implementation, clear strategies and goals, \'change champions\' to support PROMs implementation, systems to respond to issues raised by PROMs, and integration into patient pathways. No consensus favoured paper or electronic PROMs, yet offering both options to mitigate digital literacy bias and integrating PROMs into electronic health records emerged as important facilitators.
CONCLUSIONS: The sustainable implementation of PROMs is a complex process that requires multicomponent organisational strategies covering training and guidance, necessary time and resources, roles and responsibilities, and consultation with patients and clinicians.
摘要：
目的：作为提高医疗质量的一种机制，患者报告结果测量（PROM）得到了广泛的支持。我们旨在绘制出影响日常临床实践中PROM实施策略的关键促成因素和障碍。
方法：进行了一项总括性审查，以确定从2000年1月至2023年6月在常规临床实践中探索与PROM整合相关的促成因素和障碍的审查。根据理论领域框架，以主题方式提取和总结了有关关键推动者和障碍的信息。
结果：34条评论符合我们的纳入标准。确定的评论强调了障碍，例如临床医生和患者对PROM的认识有限，临床医生和患者感知到的低价值，对患者来说过于复杂或难以完成的PROM，PROM系统的可用性差，PROM数据的延迟反馈，临床医生担心使用PROM作为绩效管理工具，患者对隐私和安全的担忧，和资源约束。促进者包括分阶段实施，专业培训,实施前的利益相关者参与，明确的战略和目标，“更改冠军”以支持PROM实施，系统来回应由PROM提出的问题，并融入患者路径。没有共识赞成纸质或电子项目，然而，提供两种选择来减轻数字素养偏见和将PROM集成到电子健康记录中成为重要的促进者。
结论：PROM的可持续实施是一个复杂的过程，需要涵盖培训和指导的多部分组织战略，必要的时间和资源，角色和责任，并咨询患者和临床医生。
方法：进行了一项总括性审查，以确定从2000年1月至2023年6月在常规临床实践中探索与PROM整合相关的促成因素和障碍的审查。根据理论领域框架，以主题方式提取和总结了有关关键推动者和障碍的信息。
结果：34条评论符合我们的纳入标准。确定的评论强调了障碍，例如临床医生和患者对PROM的认识有限，临床医生和患者感知到的低价值，对患者来说过于复杂或难以完成的PROM，PROM系统的可用性差，PROM数据的延迟反馈，临床医生担心使用PROM作为绩效管理工具，患者对隐私和安全的担忧，和资源约束。促进者包括分阶段实施，专业培训,实施前的利益相关者参与，明确的战略和目标，“更改冠军”以支持PROM实施，系统来回应由PROM提出的问题，并融入患者路径。没有共识赞成纸质或电子项目，然而，提供两种选择来减轻数字素养偏见和将PROM集成到电子健康记录中成为重要的促进者。
结论：PROM的可持续实施是一个复杂的过程，需要涵盖培训和指导的多部分组织战略，必要的时间和资源，角色和责任，并咨询患者和临床医生。
