# Digitally Enhanced Routine Outcome Monitoring in Italian Psychotherapy: Protocol for a Longitudinal Implementation Study

## TL;DR

This study explores how to implement a digital platform for routine outcome monitoring in Italian psychotherapy, focusing on factors that influence adoption in fragmented healthcare systems.

## Contribution

The study introduces a theory-informed, mixed-methods longitudinal approach to implementing digital outcome monitoring in psychotherapy within a fragmented healthcare system.

## Key findings

- A digital platform for routine outcome monitoring is being tested in diverse Italian psychotherapy settings.
- The study combines qualitative and quantitative data to understand implementation trajectories.
- Findings will inform how digital tools can be integrated into routine clinical practice in fragmented systems.

## Abstract

Routine outcome monitoring (ROM) is an evidence-based methodology in psychotherapy that supports clinical decision-making through the standardized and systematic collection of patient-reported outcome data. Although its benefits are well established, ROM remains poorly integrated into routine psychotherapeutic practice in many countries, including Italy. Structural fragmentation of services, limited digital infrastructure, and cultural resistance within the profession hinder the adoption of data-informed clinical practices.

This study aims to investigate the implementation of a digital platform designed to support ROM in Italian psychotherapy, with a focus on individual, organizational, and contextual factors influencing adoption and integration into everyday clinical practice.

This is a longitudinal, mixed methods implementation study embedded within the OutProFeed project, the first randomized controlled trial in Italy focused on ROM in psychotherapy. The study is guided by the Consolidated Framework for Implementation Research, which informed the selection of constructs through a structured expert consensus process. Approximately 30 psychotherapists are included across diverse practice settings, therapeutic orientations, and geographic areas. Data will be collected at three time points (T0 baseline, T1 midimplementation at ~6 mo, and T2 final follow-up at ~12 mo). Qualitative data will be generated through semistructured interviews, while quantitative data will be collected using the Evidence-Based Practice Attitude Scale–36 (EBPAS-36). Qualitative and quantitative data will be linked at the individual level to support integrated interpretation of implementation trajectories.

The study received ethical approval from the Ethics Committee of the University of Bergamo in April 2024. Technical setup of the digital platform and preimplementation engagement with participating psychotherapists were conducted between May and November 2025. Baseline (T0) implementation data collection started on a rolling basis in December 2025 and is planned to continue through March 2026. The midimplementation follow-up (T1; approximately 6 mo after individual baseline) is expected to occur between June and October 2026, with the final follow-up (T2; approximately 12 mo after baseline) planned between December 2026 and April 2027. Data analysis will begin after completion of follow-up assessments, with initial findings expected to be submitted for publication in 2027.

This protocol outlines a theory-informed and context-sensitive approach to studying the implementation of digitally supported ROM in psychotherapy. By combining qualitative and quantitative data within a longitudinal design, the study aims to generate insights into the conditions under which digital outcome monitoring may be integrated into routine psychotherapeutic work in fragmented and professionally autonomous health care systems.