title: Functionality and feedback: a protocol for a realist synthesis of the collation, interpretation and utilisation of PROMs data to improve patient care.
abstract: BACKGROUND
  The feedback and public reporting of PROMs data aims to improve the quality of care provided to patients. Existing systematic reviews have found it difficult to draw overall conclusions about the effectiveness of PROMs feedback. We aim to execute a realist synthesis of the evidence to understand by what means and in what circumstances the feedback of PROMs data leads to the intended service improvements.
  
  
  METHODS
  Realist synthesis involves (stage 1) identifying the ideas, assumptions or 'programme theories' which explain how PROMs feedback is supposed to work and in what circumstances and then (stage 2) reviewing the evidence to determine the extent to which these expectations are met in practice. For stage 1, six provisional 'functions' of PROMs feedback have been identified to structure our review (screening, monitoring, patient involvement, demand management, quality improvement and patient choice). For each function, we will identify the different programme theories that underlie these different goals and develop a logical map of the respective implementation processes. In stage 2, we will identify studies that will provide empirical tests of each component of the programme theories to evaluate the circumstances in which the potential obstacles can be overcome and whether and how the unintended consequences of PROMs feedback arise. We will synthesise this evidence to (1) identify the implementation processes which support or constrain the successful collation, interpretation and utilisation of PROMs data; (2) identify the implementation processes through which the unintended consequences of PROMs data arise and those where they can be avoided.
  
  
  BACKGROUND
  The study will not require NHS ethics approval. We have secured ethical approval for the study from the University of Leeds (LTSSP-019). We will disseminate the findings of the review through a briefing paper and dissemination event for National Health Service stakeholders, conferences and peer reviewed publications.
authors: School of Sociology and Social Policy, University of Leeds, Leeds, UK.
authors: Joanne
authors: J
authors: Greenhalgh
authors: School of Sociology and Social Policy, University of Leeds, Leeds, UK.
authors: Ray
authors: R
authors: Pawson
authors: Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors: Judy
authors: J
authors: Wright
authors: London School of Hygiene and Tropical Medicine, London, UK.
authors: Nick
authors: N
authors: Black
authors: University of Exeter Medical School, Exeter, UK.
authors: Jose Maria
authors: JM
authors: Valderas
authors: Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors: David
authors: D
authors: Meads
authors: Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors: Elizabeth
authors: E
authors: Gibbons
authors: Patient Representative, Leeds, UK.
authors: Laurence
authors: L
authors: Wood
authors: Northern & Yorkshire Knowledge and Intelligence Team, Public Health England, Leeds, UK.
authors: Charlotte
authors: C
authors: Wood
authors: Leeds West Clinical Commissioning Group, Leeds, UK.
authors: Chris
authors: C
authors: Mills
authors: School of Sociology and Social Policy, University of Leeds, Leeds, UK.
authors: Sonia
authors: S
authors: Dalkin
mesh_terms: D003625:Data Collection; D003627:Data Interpretation, Statistical; D005246:Feedback; D006801:Humans; D005791:Patient Care; D017060:Patient Satisfaction; D058996:Quality Improvement; D011795:Surveys and Questionnaires
keywords: PROMs; Patient Reported Outcome Measures; Realist Synthesis; feedback; service delivery