Developing a learning collaborative: A strategy or a compilation of strategies for implementation of remote symptom monitoring.

472 Background: Learning collaboratives are a widely used to support the spread of complex innovations, but little is known about how learning collaboratives develop. The OncoPRO initiative, a PCORI-funded national learning collaborative hosted by ASCO focused on implementing remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROs) in oncology, provides a unique opportunity to explore this process. This study offers critical insights into both the development of learning collaboratives and their ability to support the long-term success of complex healthcare initiatives. Methods: This study employed a multi-methods implementation science approach to examine the development and first year of the OncoPRO initiative. In its initial year (January-December 2024), OncoPRO provided support to 12 independent health systems. We identified cross-organizational barriers encountered during collaborative development, as well as the implementation strategies employed to address them, using field notes generated during all OncoPRO-related meetings, site-level communications, and presentations. We systematically identified and categorized barriers and implementation strategies using the Consolidated Framework for Implementation Research (CFIR) 2.0 and the Expert Recommendations for Implementing Change (ERIC) frameworks. Results: We identified 27 overarching barriers (e.g., lack of best practices; lack of buy-in) that were addressed through 23 foundational implementation strategies relevant to developing and facilitating the learning collaborative. These implementation strategies were organized temporally into six phases: building a multi-level foundation, engaging and onboarding implementation sites, building shared learning structures, supporting technical rollout, embedding feedback loops and quality monitoring, and stimulating demand for RSM and collaborative participation. Most barriers were addressed using multiple strategies, and individual strategies often targeted several barriers simultaneously. Broad strategies addressing multiple barriers (e.g. build a coalition; identify early adopters) were deployed early to develop a base for the collaborative. As the initiative matured, strategies targeting specific barriers (e.g. develop and implement quality monitoring systems) were added to support site-level operationalization and continuous improvement. Conclusions: This approach to building a national learning collaborative offers a roadmap for constructing and sustaining complex collaboratives. It lays the groundwork for future analyses of implementation variation and strategy effectiveness across sites, and highlights how learning collaboratives can be pivotal in supporting the successful implementation of complex quality initiatives like RSM in oncology.