Clinical Integration of Digital Patient-Reported Outcome Measures in Primary Health Care for Chronic Disease Management: Protocol for a Systematic Review

Background Health measurement guides policies and health care decisions are necessary to describe and attain the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. In the primary care setting, patient-reported outcome measurement allows outcome comparisons within and across settings and helps improve the clinical management of patients. However, these digital patient-reported outcome measures (PROMs) are still not adapted to the clinical context of primary health care, which is an indication of the complexity of integrating these tools in this context. We must then gather evidence of their impact on chronic disease management in primary health care and understand the characteristics of effective implementation. Objective We will conduct a systematic review to identify and assess the impact of electronic PROMs (ePROMs) implementation in primary health care for chronic disease management. Our specific objectives are to (1) determine the impact of ePROMs in primary health care for chronic disease management and (2) compare and contrast characteristics of effective ePROMs’ implementation strategies. Methods We will conduct a systematic review of the literature in accordance with the guidelines of the Cochrane Methods Group and in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for its reporting. A specific search strategy was developed for relevant databases to identify studies. Two reviewers will independently apply the inclusion criteria using full texts and will extract the data. We will use a 2-phase sequential mixed methods synthesis design by conducting a qualitative synthesis first, and use its results to perform a quantitative synthesis. Results This study was initiated in June 2022 by assembling the research team and the knowledge transfer committee. The preliminary search strategy will be developed and completed in September 2022. The main search strategy, data collection, study selection, and application of inclusion criteria were completed between October and December 2022. Conclusions Results from this review will help support implementation efforts to accelerate innovations and digital adoption for primary health care and will be relevant for improving clinical management of chronic diseases and health care services and policies. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42022333513; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333513 International Registered Report Identifier (IRRID) DERR1-10.2196/48155

Au nom des Instituts de recherche en santé du Canada (IRSC) nous avons le plaisir de vous informer que la demande de subvention que vous avez présentée récemment au concours Subvention Catalyseur : Quatre objectifs et équité qui s'intitule "Clinical integration of digital patient-reported outcomes in primary healthcare for chronic diseases management -a systematic review (inPR1nt)" a été approuvée.Les documents relatifs à vos évaluations se trouvent sur RechercheNet.Veuillez noter que votre autorisation de financement suivra par courrier.
Aujourd'hui, l'activité scientifique est surveillée de près et il est plus important que jamais de veiller à ce que notre travail soit bien compris.Je vous demande donc de faire mention du financement des IRSC dans vos présentations et vos communications au sujet de vos recherches, et de continuer de faire valoir l'importance cruciale de la recherche pour la santé des Canadiennes et des Canadiens.Vous trouverez à l'adresse https://cihr-irsc.gc.ca/f/30789.htmldes moyens de reconnaître le soutien reçu et découvrirez comment l'équipe des Communications des IRSC peut vous aider à faire connaître votre recherche.Clinical integration of digital patient-reported outcomes in primary healthcare for chronic diseases management -a systematic review (inPR1nt) Scientific Merit: 1. Concept: Quality of the Idea.
Overall goals and objectives are well-defined and clearly linked to the objective of advancing and informing progress towards quadruple aim and equity for all, focused on implementation of PROMS in primary care to advance chronic disease management.The project is solely focused on a detailed and robust systematic review of evidence.It does not reach further to define recommendations or strategies to introduce PROMS for primary care, although this is implied.The project clearly responds to the objectives of advancing Quadruple Aim by documenting and defining outcomes measurement in primary care for management of chronic illness.Makes a strong case for the importance of outcomes measurement in primary care to document achievement of quadruple aim.

Feasibility:
Approaches, methods, and integration of sex and gender not clearly described relative to proposed outputs or contributions.Sex and gender are briefly acknowledged, no mention of particular analysis of how current evidence informs or documents sex and gender considerations.Applicant team and knowledge users described well, clearly engaging knowledge users in the iKT process.Timelines and deliverables are feasible.

Team's expertise and experience
PI has an extensive track record of funding and publications relevant to primary care, patient oriented research, less focus on quadruple aim in health systems.Engagement of the applicant team described briefly, but no specific tasks of each is described.Potential research foundation for collaborative research not clearly defined, but could have been.
iKT plan is strong, well developed, accessing national networks of leaders and collaborators via SPOR networks across Canada.
Potential Impact.
The project addresses high-priority evidence needs relative to the integration of PROMS into primary care to advance patient outcomes, workforce outcomes, quality, safety and cost.Relies on a systematic review of literature, stops short of advancing findings in the context of Canadian primary care, which would have further strengthened the potential impact.Clinical integration of digital patient-reported outcomes in primary healthcare for chronic diseases management -a systematic review (inPR1nt) Applicants propose to conduct a systematic review of the literature on the impact of digital PROMs in primary healthcare and to identify effective implementation strategies.The review of the literature is incomplete with previews reviews missing.In addition, work published by CIHI and by APERSU on PROMs is not included.The application fails to provide convincing information on the need for this research or on future research that would build on this project.
1: Concept Quality of the idea: o The overall goals and objectives of the project are not well-defined and clear, with distinct outputs and anticipated outcomes that will support advances in knowledge, research, health care, health systems, and/or health outcomes related to one or more of the Quadruple Aim goals and health equity for all.
2: Feasibility Approach o The approaches, methods and integration of sex and gender appropriate to deliver the proposed output(s) and achieve the proposed contribution(s) are feasible.Team's expertise and experience o The applicant team does not appear to be aware of Canadian initiatives.Clinical integration of digital patient-reported outcomes in primary healthcare for chronic diseases management -a systematic review (inPR1nt)

Strengths:
-The committee felt that the area of study (how to incorporate the use of digital PROMs in primary care) was very worthwhile.Primary care and management of chronic disease is a priority for all health systems, and a tool that could effectively engage patients to report their outcomes, particularly if it could be linked to improving self-management was seen as important -The study methods were felt to be strong, incorporating use of Cochrane methods for systematic review and RE-AIM -This was felt to be a strong team with very good expertise, including a strong PI who was connected to researchers across Canada

Weaknesses:
-The knowledge translation plan was not as strong as other aspects of this grant.While appropriate knowledge users were involved, to maximize the impact of this work, engagement of additional knowledge users was recommended.For instance, the applicants were encouraged to engage CIHI, the Canadian Network for Digital Health Evaluation, and individuals and knowledge users working in this area in other provinces.The committee felt that other knowledge users would be important to scaling this type of innovation.

Budget:
-No concerns noted Clinical integration of digital patient-reported outcomes in primary healthcare for chronic diseases management -a systematic review The final rating of the application, provided in the Notice of Decision (NOD), is the averaged rating of the peer review committee members following the discussion of the application during the committee meeting, and therefore may differ from the ratings provided by the assigned reviewers in their respective reviews.
Project will inform future decisions, policies, or actions that advance achievement of the Quadruple aim, 3: Potential ImpactThe application does not state to what extent the project will inform future decisions, policies or actions that advance achievement of the Quadruple Aim goals and health equity for all?