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Purpose: The objective of this study is to present the implementation science approaches that were used before implementing electronic patient-reported outcome measures (ePROMs) across an integrated chronic pain network that includes primary, rehabilitation, and hospital-based care. Methods: The Theoretical Domains Framework (TDF) was used to identify potential barriers and enablers to the use of ePROMS by primary care clinicians. In rehabilitation and tertiary care, the Consolidated Framework for Implementation (CFIR) was used to guide the identification of determinants of implementations, through observation of workflow, patient and clinician surveys, and clinician interviews. A mixed-method concurrent design comprising a quantitative and qualitative analysis was used. The results were reviewed by a steering committee to iteratively inform the ePROM implementation plan. The Proctor framework of evaluation was used to guide the development of an evaluation plan for the implementation of ePROMs in the integrated chronic pain network. Results: Both frameworks provided similar results with respect to healthcare provider knowledge, behaviour, and experience interpreting PROM scores. The TDF and CFIR frameworks differed in identifying organizational-level determinants. The resultant implementation plan was structured around the adoption of PROMs to inform individual treatment planning and quality improvement. The evaluation plan focused on implementation and impact outcomes to evaluate the ePROM intervention. Conclusions: The TDF and CFIR guided the development of a multi-component knowledge translation and training intervention that will address multiple gaps and barriers to implementation of PROMs across the integrated network. The ePROM intervention will aim to increase clinicians' knowledge and skills and foster best practices. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a common public health problem with negative consequences for individuals and societies. Fortunately, interdisciplinary chronic pain management has been shown to be effective for improving patients' outcomes and strongly recommended in clinical practice guidelines. Appropriate referral within the healthcare system based on individuals' needs and available services is essential to optimise health-related outcomes and maximise resources. Clinical decision support systems have been shown to be effective for supporting healthcare professionals in different practices. However, there is no knowledge synthesis on clinical decision support systems for referral within chronic pain practice. We aim to identify the clinical decision support systems for referral within chronic pain practices and assess their content, effectiveness, harms, and validation parameters. Methods: Using the methodology of Cochrane reviews, we will perform a systematic review and meta-analysis based on studies meeting the following criteria: Population, patients with chronic pain and/or healthcare professionals working in chronic pain; Intervention, clinical decision support systems for referral within chronic pain practice; Comparison, any other clinical tool, any usual care or practices; Outcomes, clinical outcomes of patients measuring how patients feel, function or survive including benefits, adverse effects, continuity of care, care appropriateness, care satisfaction, quality of life, healthcare professional performance, and cost outcomes; and Study design: randomized controlled trials, non-randomized controlled trials, before and after controlled studies and interrupted time series. We will search relevant literature with the support of an information specialist using Medline, Embase, PsycInfo, CINHAL, Web of Science and Cochrane Library from their inception onwards. Two reviewers will independently complete study selection, data extraction and risk of bias assessment. We will analyse data to perform both narrative syntheses and meta-analysis if appropriate. Discussion: Findings of this review will contribute to enhancing chronic pain care and research. Clinical decision support systems identified as effective in this review can be investigated for implementation in clinical practice and impact on improving patient, clinical and health system outcomes. Clinical decision support systems not yet ready for implementation that require further improvement will also be identified. Systematic review registration: PROSPERO registration: CRD42020158880. [ABSTRACT FROM AUTHOR]

Purpose: To identify a core patient-reported outcome (PRO) domain set to be used in routine clinical care in settings offering specialized and supra-specialized multidisciplinary care to individuals with chronic pain (CP).Methods: Two online cross-sectional surveys were administered: one with healthcare professionals (HCPs) and one with individuals with CP. Both surveys included domains of health-related quality of life (HRQoL) from the Patient-Reported Outcomes Measurement Information System (PROMIS) framework. The patients' survey also included the Patient Generated Index (PGI). Areas affected by CP identified in the PGI were mapped to The International Classification of Functioning, Disability and Health (ICF).Results: According to HCPs, the five most relevant HRQoL domains to be assessed in routine clinical care were pain interference, pain intensity, physical function, anxiety and depression. The five areas that were the most valued by individuals with CP were recreation and leisure; global mental function; work and employment; household tasks and walking and moving. In total, these represented 74% of all nominated areas. When triangulating both frameworks (ICF/PROMIS) and perspectives (HCPs/patients), 10 core PRO domains were identified: pain interference, pain intensity, physical function, sleep disturbance, anxiety, depression, ability to participate in social roles and activities, fatigue, sleep-related impairments and self-efficacy.Conclusions: This study identified 10 core PRO domains covering the physical, psychological and social consequences of CP on an individual's life from the perspective of individuals with CP and HCPs. The results can help identify appropriate PRO measures to assess the outcomes of multidisciplinary interventions. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the health-related quality of life (HRQoL) domains currently assessed by healthcare professionals (HCPs) in secondary and tertiary hospital-based chronic pain clinics and the type of clinical outcomes (CO) used.Methods: Electronic cross-sectional survey (May to September 2016) based on domains of HRQoL included in the Patient-Reported Outcomes Measurement Information System (PROMIS) framework.Results: HCPs response rate was 53% (36/68). Their mean clinical experience was 14.8 years (± 11.1), and their mean experience treating chronic pain (CP) population was 10.2 years (± 7.8). All PROMIS-HRQoL domains were assessed by HCPs (range 28-97%, mean = 64%) with a preponderance of domains related to physical health (mean = 82%). Standardized outcome measures (OMs) including performance outcomes and patient-reported outcomes (PROs) were not frequently used (mean 0.5% and 3%, respectively) for assessing HRQoL domains compared to clinician reported outcomes (patient interviews, patient observation) (mean = 87%). Forty different OMs for assessing HRQoL domains were reported, and 30% of OMs were used by more than one HCP. HCPs expressed a need (range from 2.3 to 26.3%) for using more than one type of CO for assessing most domains of HRQoL (range from 2.3 to 26.3%) with a preference of using more PROs combined with CROs.Conclusions: All domains of HRQoL are assessed by at least some HCPs for chronic pain management. Standardized OMs including performance-based measures and PROs were not frequently used, and there was no consistent use of the same OM across HCPs. A consensus among different stakeholders in chronic pain management on core domains of HRQoL and their associated OMs to promote a more evidence-based assessment is needed. [ABSTRACT FROM AUTHOR]