286 Addendum for Implementation Research (CFIR) was used. Facilitating determinants were found mainly in the CFIR domains ‘intervention characteristics’, ‘characteristics of individuals’, and ‘process of implementation’, while barriers were identified in the domains ‘inner setting’ and ‘intervention characteristics’. The strategy ‘identify and prepare champions’ was acknowledged as the most effective strategy in addressing the combination of identified barriers. Based on the identified barriers and facilitators by all stakeholders the KLIK PROM portal was optimized. For example, a front-end integration between the KLIK PROM portal and the electronic health record (EHR) was realized, a mobile version of the KLIK PROM portal was developed and the lay-out was modernized. PROMs are often experienced as burdensome due to a long completion time and irrelevant and repetitive questions. To overcome this barrier, Computerized Adaptive Tests (CAT) of the Patient-Reported Outcomes Measurement Information System (PROMIS®) can be used. Chapter 7 showed that the PROMIS pediatric measures are feasible and reliable to use in clinical hemophilia care (N=76). Compared with the wellknown legacy instruments, the PROMIS pediatric measures had lower floor- and ceiling effects and the total number of items completed was lower, resulting in a reduced burden of completing PROMs. However, the number of PROMIS items administered was still relatively high. To be able to optimally implement PROMIS in clinical care, further research into the CAT stopping rule is necessary. Part 3: Patient Reported Experience Measures PCC requires feedback from patients about the received care and the extent to which care is perceived as patient-centered. Patient Reported Experience Measures (PREMs) can be used for this purpose. Although PREMs are increasingly used, there is a lack of guidelines, resulting in a wide variety of PREM use. Chapter 8 provided an overview of the available PREMs and their use in pediatric clinical care. A total of 39 different PREMs were identified that were used in 14 countries worldwide, demonstrating the growing adoption of PREMs. Nearly all of the PREMS identified were generic, designed to measure the experience of health care, regardless of disease or care setting. In addition, more than half of the PREMs were completed by proxy. The PREMs included a wide variety of domains. Communication (e.g., communication with parent, communication with child, communication about treatment, provider’s communication skills) was the most prominent domain across the various PREMs. Remarkably, PREMs are often confused with PROMs and satisfaction questionnaires, although these three types of questionnaires all have different purposes and focus
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