title: Stakeholder Engagement in a Patient-Reported Outcomes (PRO) Measure Implementation: A Report from the SAFTINet Practice-based Research Network (PBRN).
abstract: OBJECTIVE
  Patient-reported outcome (PRO) measures offer value for clinicians and researchers, although priorities and value propositions can conflict. PRO implementation in clinical practice may benefit from stakeholder engagement methods to align research and clinical practice stakeholder perspectives. The objective is to demonstrate the use of stakeholder engagement in PRO implementation.
  
  
  METHODS
  Engaged stakeholders represented researchers and clinical practice representatives from the SAFTINet practice-based research network (PBRN). A stakeholder engagement process involving iterative analysis, deliberation, and decision making guided implementation of a medication adherence PRO measure (the Medication Adherence Survey [MAS]) for patients with hypertension and/or hyperlipidemia.
  
  
  RESULTS
  Over 9 months, 40 of 45 practices (89%) implemented the MAS, collecting 3,247 surveys (mean = 72, median = 30, range: 0 - 416). Facilitators included: an electronic health record (EHR) with readily modifiable templates; existing staff, tools and workflows in which the MAS could be integrated (e.g., health risk appraisals, hypertension-specific visits, care coordinators); and engaged leadership and quality improvement teams.
  
  
  CONCLUSIONS
  Stakeholder engagement appeared useful for promoting PRO measure implementation in clinical practice, in a way that met the needs of both researchers and clinical practice stakeholders. Limitations of this approach and opportunities for improving the PRO data collection infrastructure in PBRNs are discussed.
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P). bethany.kwan@ucdenver.edu.
authors.forename: Bethany M
authors.initials: BM
authors.lastname: Kwan
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
authors.forename: Marion R
authors.initials: MR
authors.lastname: Sills
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
authors.forename: Deborah
authors.initials: D
authors.lastname: Graham
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
authors.forename: Mika K
authors.initials: MK
authors.lastname: Hamer
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
authors.forename: Diane L
authors.initials: DL
authors.lastname: Fairclough
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
authors.forename: K E
authors.initials: KE
authors.lastname: Hammermeister
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
authors.forename: Alicyn
authors.initials: A
authors.lastname: Kaiser
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
authors.forename: Maria
authors.initials: M
authors.lastname: de Jesus Diaz-Perez
authors.affiliation: From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Schilling
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D057186:Comparative Effectiveness Research / Q000379:methods / Q000458:organization & administration*; D019538:Health Care Surveys; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D055118:Medication Adherence / Q000523:psychology; D063868:Patient Outcome Assessment; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D064876:Safety-net Providers; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
keywords: Comparative Effectiveness Research; Hypertension; Medication Adherence; Patient Outcome Assessment; Patient-centered Outcomes Research; Practice-based Research