Person-centred outcome measures are commonly used in adult healthcare to measure and improve health outcomes and to support service planning and commissioning [1], but less is known about their use in children’s services [2]. The aim of this systematic review is to identify and synthesise evidence of the determinants, strategies, and mechanisms that influence the implementation of person-centred outcome measures into paediatric healthcare practice.

The review (Prospero CRD 42022330013) was conducted and reported in accordance with PRISMA guidelines. Studies were included if the setting was a children’s (0–18 years old) healthcare service, investigating the implementation or use of an outcome measure or screening tool (measure) in healthcare practice, and reported outcomes relating to use of a measure. Data were tabulated and thematically analysed through deductive coding to the constructs of the adapted-Consolidated Framework for Implementation Research. A narrative synthesis was conducted.

69 studies met inclusion criteria for the review, conducted across primary (n=14), secondary (n=13), tertiary (n=37), and community (n=8) healthcare settings, including both child self-report (n=46) and parent-proxy (n=47) measures. The most frequently reported barriers to implementation included lack of staff knowledge about how the measure may improve care and outcomes; the complexity of using and implementing the measure; and a lack of resources including funding and staff to support sustained use. The most frequently reported facilitators of implementation and sustained use include educating and training staff and families on: how to implement and use the measure, the advantages of using measures over current practice, and the benefit their use has on patient care and outcomes. Addressing logistical and resource barriers, including time, staffing, and provision of funding and resources such as office supplies, was particularly important for facilitating implementation and sustained use in lower-middle income settings.

Multiple strategies targeting different mechanisms are needed to address the determinants influencing implementation to successfully embed person-centred outcome measures into routine practice. Key strategies to address barriers to implementation include educating professionals, children and families on using measures and the benefit they have on patient care, and addressing logistical and resource barriers. A combination of the strategies identified can be used to support the development of context-specific implementation plans. This will enable the implementation of person-centred outcome measures into routine paediatric healthcare to empower health and social care providers to better identify and improve child-centred outcomes.

Øvretveit J, Zubkoff L, Nelson EC, Frampton S, Knudsen JL, Zimlichman E. Using patient-reported outcome measurement to improve patient care. International Journal for Quality in Health Care. 2017;29(6):874–9.

Huang I-C, Revicki DA, Schwartz CE. Measuring pediatric patient-reported outcomes: good progress but a long way to go. Quality of Life Research. 2014;23(3):747–50.