A Realist Evaluation of the Implementation and Use of Patient-Reported Outcomes in Four Value-Based Healthcare Programmes.

This is a realist evaluation, not a trial, so it explains how implementation worked and did not prove that PROMs caused better patient outcomes. PROMs were introduced alongside other changes such as electronic referral systems, additional staff, helplines, clinician-reported outcomes and other clinical tools, so the contribution of PROMs alone cannot be separated. Findings come from one health board in Wales and four programmes, including a programme that stopped during the evaluation because of IT problems. Many patients did not respond to surveys or could not recall completing PROMs, and the interview sample had limited diversity. Patient-level outcomes were not achieved, so the study mainly describes implementation barriers and partial service-level use rather than effective patient care.

The study was funded by Health and Care Research Wales. One author was editor of the journal but was not involved in editorial processing; all other authors declared no conflicts of interest.

Do not conclude that PROMs improve patient outcomes or shared decision-making. The evaluation found no evidence of patient-level outcomes across the programmes, and the Heart Failure service changes happened alongside electronic referral, additional staff and other clinical tools, so PROMs alone cannot be credited.