Abstract
The objectives of this study were to adapt and improve Patient-Reported Outcome Measures (PROMs) for diabetes patients in Thailand so that they align with local lifestyles and the operational workflows of different service settings, and to develop a Patient’s Journey and a standardized Service Package to support the practical implementation of PROMs in real-world settings.
This study employed a Research and Development (R&D) design combined with Implementation Research. The study was conducted in three pilot sites: Tha Wung District, Lopburi Province; Mueang District, Phetchabun Province; and La-ngu District, Satun Province. The research was carried out in two phases. Phase 1 involved the development and psychometric evaluation of the PROMs instrument. The instrument was adapted from the PRO-DM-Thai prototype and further developed into both site-specific versions and a standardized version (Central PROMs Version). The instrument was evaluated for content validity, construct validity, and reliability. Phase 2 focused on implementing PROMs through the design of a Patient’s Journey based on an analysis of the strengths and weaknesses of the three pilot areas. The findings highlighted key factors for real-world implementation, particularly the importance of demonstrating immediate benefits to healthcare providers and adding value to service delivery at each touchpoint, which facilitated acceptance. The research team collaboratively co-created with the three pilot sites to develop a Modular PROMs structure tailored to service points, capable of distributing workload and enhancing acceptance. The model was then piloted for one month.
The sample consisted of 180 patients with Type 2 Diabetes Mellitus, including 90 participants in the psychometric testing phase and 90 participants in the pilot implementation phase. Both quantitative and qualitative data were collected using questionnaires, observations, interviews, and focus group discussions. Data were analyzed using descriptive statistics and inferential statistics, including Spearman’s rank correlation coefficient and weighted kappa coefficient.
The findings indicated that the PROMs instrument was appropriate for the local context and demonstrated acceptable validity and reliability. During the pilot implementation phase, PROMs were found to be feasible for use in primary care settings, particularly when workflows were adapted to local contexts with consideration for workload and the immediate practical benefits experienced by providers. PROMs were especially effective as a communication-opening tool that increased patient awareness of the importance of self-management and helped identify important symptoms within a short period of time. Implementation outcomes reflected satisfactory levels of acceptability, feasibility, adoption, appropriateness, and compatibility with existing service workflows. However, the limited implementation period was insufficient to capture long-term health outcomes.
The findings suggest that PROMs can serve as an important tool for integrating patient-reported information into service-related decision-making and creating new experiences for both healthcare providers and patients. This demonstrates the potential of PROMs to support the development of Value-Based Health Care (VBHC). Future scale-up efforts should emphasize flexible system design, workforce capacity building, and long-term outcome monitoring.
