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

Background: 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. Objective: This study aims to investigate the implementation of a digital platform designed to support ROM in Italian psychotherapy, with a focus on the individual, organizational, and contextual factors influencing its adoption and integration into routine clinical practice. Methods: This longitudinal mixed methods implementation study is 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 (CFIR), which informed the selection of implementation constructs through a structured expert consensus process. Approximately 30 psychotherapists will be included across diverse practice settings, therapeutic orientations, and geographic areas. Data will be collected at three time points: baseline (T0), midimplementation follow-up (~6 months; T1), and final follow-up (~12 months; T2). 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 findings will be linked at the individual level to support an integrated interpretation of implementation trajectories. Results: The study received ethical approval from the Ethics Committee of the University of Bergamo in April 2024. The technical setup of the digital platform and preimplementation engagement with participating psychotherapists were conducted between May and November 2025. Baseline (T0) data collection began on a rolling basis in December 2025 and is expected to continue through March 2026. Midimplementation follow-up assessments (T1) are expected between June and October 2026, while final follow-up assessments (T2) are planned between December 2026 and April 2027. Data analysis will begin following completion of the follow-up phase, and initial findings are expected to be submitted for publication in 2027. Conclusions: This protocol outlines a theory-informed and context-sensitive approach to studying the implementation of digitally supported ROM in psychotherapy. By integrating qualitative and quantitative data within a longitudinal design, the study aims to generate insights into the conditions under which digital outcome monitoring can be effectively integrated into routine psychotherapeutic practice within fragmented and professionally autonomous health care systems.