Table 4 Codebook: Facilitators (F), barriers (B) and neutral statements (N) per qualitative theme

Stakeholders

Any statements about the engagement of stakeholders at the meso and macro level in order to succeed

B/F

B/F/N

F/N

Subjectivity of PROMs

Any statements indicating that PROMs are subjective measures, and patients are not able to distinguish between consequences and complications of treatment

B

B

–

Aligning PROMs with clinical data

Statements concerning the discrepancy between PROMs and clinical outcome

B

–

PROMs versus PREMs

Any statements indicating that clinicians (consultants) did not distinguish the difference between PROMS and measures of patient satisfaction or experience

B

–

–

 Data collection

  Choice of measure

Any statements indicating the choice of measure, such as type of measurement (generic vs disease-specific), length of measurement, reliability and validity of measurement

B

B/F/N

B/N

  Timing of data collection

Any statements indicating the timing of data collection and how this would influence performance ranking at different time points

B

–

–

  Response rate of measurement

Any statements indicating the response rate from patients, for example short-term follow-up (high response rate), while using the collection of longitudinal data with repeated measures (low response rate). Clinician discusses results with patients (high response rate even though long-term follow up)

–

B

B

  Focus of measurement

Any statements indicating the importance of focusing on this measurement within this field, such as clinical value of expected improvements in outcome and variability between professionals

B

–

–

 Data processing

  Representativeness of collected data

Any statements concerning representativeness of the data when using PROMs for quality improvement strategies. On the one hand, related to patients, this includes selection bias, inadequate answers, health literacy and nonresponse. On the other hand, related to healthcare professionals, these include selection and treatment bias, comparison between healthcare professionals, and confidentiality of reporting

B

B

B/N

  Responsibility of healthcare professionals

Any statements concerning being held responsible for outcome data and its consequences

B

B

B/N

  Inadequate case-mix control

Any statements concerning the use of case mix and effect on making comparisons between professionals

–

B

B/N

  Interpretation of feedback

Any statements about the (mis)interpretation of feedback by experts, training for interpretation, or norm values for performance indicators

B/N

B

–

  Resources

Any statements indicating the infrastructure of data collection, such as availability or complexity of electronic data collection methods, or incorporation and use of resources for data collection in normal workflow/routine care related to additional workload for PROMs collection, interpretation and usage

B

B/F/N

B/F