Title: Functionality and feedback: A realist synthesis of the collation interpretation and utilisation of PROMs data to improve patient care
Funder: Department of Health (England)

Abstract: The aim of this project is to review the evidence to understand how and in what circumstances the feedback of patient reported outcome measures (PROMs) improves the quality of patient care. The impact of PROMs feedback on the quality of patient care depends on a long complex chain of inputs and outputs and is greatly affected by where and how it is implemented. This complexity has made it difficult for existing systematic reviews to provide a definitive answer regarding whether PROMs feedback improves patient care. In this project we will use a different review method Realist Synthesis (RS) to clarify the different purposes of PROMs feedback and identify the circumstances under which PROMs feedback works best and why in order to inform its future implementation within the NHS. Realist synthesis involves (Stage 1) identifying the ideas assumptions or ‘programme theories’ which explain how interventions are supposed to work and in what circumstances and then (Stage 2) reviewing the evidence to determine the extent to which these expectations are met in practice. For Stage 1 we have provisionally identified six ‘functions’ of PROMs feedback to structure the review. At the individual level PROMs data are utilised to improve patient care by (i) screening for undetected problems; (ii) monitoring patients’ problems over time and (iii) involving the patient in decisions about their care. At the group level PROMs data may improve patient care by (iv) improving the appropriateness of the use of interventions; (v) stimulating quality improvement activities or (vi) informing decision making about choice of provider. We will identify the different programme theories that underlie each function and develop a logic map of the respective implementation processes showing how the collation interpretation and utilisation of PROMs data is intended to improve patient care. In Stage 2 we will identify studies that will provide empirical tests of each component of the programme theories. This will include existing systematic reviews of PROMs feedback (to test theory relating to the impact of PROMs on patient care across different contexts) and qualitative studies of provider views and experiences of PROMs feedback (to test theory relating to stakeholders different reactions to PROMs feedback ie the mechanisms through which PROMs feedback works). For some of the more recent ambitions of PROMs feedback at the group level there may be relatively little direct evidence. To interrogate these ideas we will also include literature with a similar programme theory for example studies evaluating feedback and public reporting of mortality report cards and other performance reporting initiatives in the US. We will synthesise this evidence to identify the implementation processes which support or constrain the successful collation interpretation and utilisation of PROMs data to improve patient care. Through developing and then testing and refining these programme theories against existing evidence we will identify what support is needed to optimise the impact of PROMS feedback and distinguish the conditions (eg settings patient populations nature and format of feedback) where PROMs feedback might work best. We will produce guidance to enable NHS decision makers to tailor the collection and utilisation of PROMS data to local circumstances and maximise its impact on the quality of patient care.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE