129 Barriers to and enablers of the use of the Otology Questionnaire Amsterdam in clinical practice 7 Introduction In the past few decades, recognition for providing patient-centred care has grown significantly, which has translated into the increasing development of patientreported outcome measures (PROMs).1,2 The use of these outcomes can lead to improving the patient-clinician relationship and increasing the patient’s participation in determining treatment.2,3 In addition, PROMs can be utilized to compare healthcare providers, settings, and patient groups, which may lead to improving the quality of healthcare.1 However, before the potential benefits can be achieved, PROMs need to be successfully implemented in clinical settings. The implementation of PROMs into routine care is known as a challenging process, as it requires a shift in the clinical practice and changes in the individual behaviour of healthcare providers and patients.4,5 Previous studies have demonstrated the above through capturing the limited uptake of PROMs in clinical practices.3,6 An essential part of Implementation science (IS) is the use of theories and frameworks, which can provide insight into why the implementation of an innovation succeeds or fails.7 The core of these IS approaches is twofold: 1 identifying barriers to and enablers of the implementation of the innovation as experienced by individuals, providers, organizations, or other stakeholder groups and 2 developing and applying an implementation strategy that address the barriers and enablers.8 Prior research has demonstrated that the IS approach is largely harmonious with the implementation of PROMs and that their frameworks can be applied to improve clinical adoption.3,9 The Otology Questionnaire Amsterdam (OQUA) has been implemented as part of standard care in in Amsterdam UMC by December 2020. It is developed to evaluate multiple ear complaints and their impact on patients’ daily lives.10 The questionnaire contains 34 items and covers eight ear complaints (earache, pressure sensation, itching, tinnitus, hearing loss, ear discharge, loss of taste, dizziness) and their impact (11). The Dutch validated version of the OQUA by Kraak11 et al. can be found as an appendix at the end of this thesis. The OQUA is linked to all surgical otological interventions, in which the patient automatically receives an invitation to complete the questionnaire 2 weeks before and 3 and 12 months after intervention. Pre- and post-intervention scores are used to evaluate the effectiveness of the surgical intervention from the patient’s perspective. An example of the graphical representation of the OQUA is provided as an additional online S2 at the end of this chapter. In addition, the OQUA has been implemented by other hospitals, including Noordwest Ziekenhuisgroep (NWZ) and Deventer Hospital.
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