156 Chapter 6 us to use a standardized framework to explain the influence of each domain on the implementation outcomes of an evidence-based PROM portal. With years of experience in the development and implementation, the KLIK PROM portal is now in a phase of understanding what barriers and facilitators have already been resolved and determining what major determinants are currently of influence to move to the next area of implementation: sustainability. Methods The evidence-based KLIK PROM portal The development and implementation of the KLIK PROM portal is based on multiple studies (Supplemental Table 1). The predecessor of the KLIK ePROfile was the QLICON PROfile [25]. During the QLIC-ON study, two generic HRQOL questionnaires widely used in pediatrics (TAPQOL [26] and PedsQL [27]) were converted into digital questionnaires. Patients were asked to complete a HRQOL questionnaire on a laptop in the waiting room of the outpatient clinic, prior to the visit. The literal answers and graphs were printed out, fed back to the pediatrician in a QLIC-ON PROfile on paper, and discussed with patients and parents during the consultation [25]. However, completing PROMs at the outpatient clinic and providing hard copy PROfiles was logistically complicated, and therefore, they are hard to implement in a real-world situation. As a result, the KLIK website (www.hetklikt.nu) was developed during the KLIK study in pediatric rheumatology [28]. From that moment, children and parents completed the questionnaires online at home. The implementation of KLIK, as part of standard care, started in 2011 [7,12]. To gain more insight into the implementation process and outcomes, a study was conducted to identify barriers and enablers in this process in pediatric oncology [29]. Currently, KLIK is part of standard care in >70 different patient groups (e.g., diabetes, nephrology) in >20 centers in the Netherlands and 3 centers in the United Kingdom. Over 17,000 patients are registered on the KLIK website and around 1,000 clinicians (e.g., physicians, nurses, psychologists) have been trained in the use of KLIK. KLIK is implemented in various settings, including hospital outpatient clinics, rehabilitation centers, and recently in dentistry. KLIK was initially developed for use in pediatrics, but since 2017 KLIK has also been implemented in adult care (e.g., coagulation diseases and medical psychology). The KLIK expert team of the Emma Children’s Hospital Amsterdam UMC coordinates the implementation of the KLIK PROM portal in pediatrics and adult healthcare in 20 hospitals in the Netherlands. The KLIK
RkJQdWJsaXNoZXIy MTk4NDMw