12 Chapter 1 KLIK PROM portal To facilitate the use of PROMs in clinical practice, the Emma Children’s hospital Amsterdam UMC developed the evidence-based KLIK PROM portal (www.hetklikt. nu) [47-50]. In the last 12 years, the KLIK PROM portal has been implemented in more than 40 hospitals in the Netherlands for pediatric and adult outpatient clinics [51]. In these hospitals, patients (children or adults) and/or caregivers complete online PROMs before an outpatient consultation to assess their physical, mental and/or social health (see Figure 3). Answers are converted into an electronic individual dashboard offering a broad range of feedback options customized to each specific PROM [52]. Clinicians discuss the KLIK dashboard with patients during the consultation with the aim to facilitate communication, monitor well-being over time, identify problems, and subsequently provide tailored advice and interventions. Figure 3. The KLIK workflow Implementation of the KLIK PROM portal The KLIK expertise center for PROMs and PREMs guides the implementation of PROMs in different multidisciplinary teams. Implementation strategies are crucial to reach the intended effects, but it remains challenging [53,54]. Implementation research can help to get insight into barriers and facilitators prior to implementation and can therefore ease the integration of PROMs in clinical care [55]. Implementation research is defined as the “scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical settings in order to improve patient outcomes and benefit population health” [56]. Implementation research thus studies the mechanisms that influence implementation outcomes. Different implementation sciences models, theories and frameworks can be used to identify determinants (both barriers and facilitators) that influence the implementation outcome and provide implementation strategies as potential solution to barriers [56]. The Consolidated Framework for Implementation Research (CFIR) is a commonly used framework within PROM implementation [57]. This framework consists of five domains (intervention characteristics, outer setting, inner setting, characteristics of individuals, and implementation process), each with a
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