From framework to practice: applying the proteus-practice framework to learn lessons for integrating PROs in clinical care.

Abstract

As the use of patient-reported outcomes (PROs) in clinical practice expands, there is a growing need to understand how PROs are being integrated across diverse healthcare settings. We aimed to use the PROTEUS-Practice Framework to systematically describe real-world approaches to PRO integration into clinical care and identify lessons learned. Participants in the international PROTEUS Consortium were invited to submit case studies describing PRO applications in clinical care. Contributors completed a structured template aligned with the PROTEUS-Practice Framework, which outlines 16 steps for PRO integration across design, implementation, and management stages. Case studies were descriptively summarized by framework step and responses were thematically analyzed by framework stage to identify lessons learned. Five case studies described the integration of PROs in diverse clinical contexts, including three within individual health systems and two spanning multiple health systems. Fifteen cross-cutting lessons learned emerged across the PROTEUS-Practice Framework stages. Themes identified in at least three case studies include the importance of stakeholder training during design, PRO champions during implementation, and EHR integration to support management. Clear goals, alignment of expected outcomes, iterative design processes, user-friendly visualizations, and regular system updates were also commonly emphasized as critical to successful integration. The PROTEUS-Practice Framework provided a structured approach for describing real-world approaches to PRO integration in clinical care. Its use enabled the identification of cross-cutting lessons learned that offer practical guidance for optimizing PRO integration and tailoring its use in diverse clinical contexts.