Abstract
BACKGROUND: Patient-Reported Outcome Measures (PROMs) are vital for patient-centred care but face implementation challenges. Within the participating academic medical centre's spine care and pain management clinics, PROMs were collected but underused, indicating a quality gap. OBJECTIVE: To identify and compare physician and patient perspectives on priorities, barriers and preferences for PROM implementation to inform a quality improvement initiative. METHODS: We conducted a mixed-methods evaluation (October 2024-December 2024) in two outpatient clinics. Data included quantitative surveys assessing priorities and challenges from physicians (N=8) and patients (N=35), and qualitative data from physician meeting field notes, patient interaction field notes and open-ended survey responses. Quantitative data were analysed descriptively; qualitative data underwent thematic analysis. Findings were integrated using triangulation. RESULTS: Physicians and patients aligned on prioritising pain interference and physical function. However, patients prioritised pain severity and personal goals more highly than physicians. While 70% of patients found PROMs useful, only 24% reported discussing PROM findings with providers, and 75% of clinicians responded 'not at all confident' to a question about score interpretation. Implementation challenges diverged significantly: physicians universally (100%) cited perceived patient time burden as a barrier, but this concern was infrequently shared by patients (11.4%). Physicians also cited workflow integration as a barrier (87.5%), while patients primarily prioritised PROM format/design (37.1%) and relevance (28.6%). Five qualitative themes emerged across patients and physicians: (1) critiques of PROM content/fidelity; (2) disconnect between data collection and clinical integration; (3) prioritising function and patient-centred goals; (4) need for flexibility, customisation and communication and (5) system-level barriers influencing implementation. CONCLUSIONS: Gaps exist between PROM collection and meaningful clinical use in this setting, driven by content limitations, workflow barriers, system issues and divergent stakeholder perspectives. Improving PROM implementation requires a multistakeholder approach prioritising function-focused, relevant measures integrated effectively into clinical workflows and support by system-level changes.