Implementation of child-centred outcome measures in routine paediatric healthcare practice: a systematic review
Authors: Scott Hannah May , Braybrook Debbie , Harðardóttir Daney , Ellis-Smith Clare , Harding Richard ,   On behalf of C-POS, Anderson AK , Bayly Jo , Bate Lydia , Bluebond-Langner Myra , Box Debbie , Bristowe Katherine , Burman Rachel , Chambers Lizzie , Coombes Lucy , Craft Alan , Craig Fin , Delaney Aislinn , Downie Jonathan , Downing Julia , Farsides Bobbie , Fovargue Sara , Fraser Lorna , Green Jane , Halbert Jay , Hall-Carmichael Julie , Higginson Irene , Hills Michelle , Hocaoglu Mevhibe , Holme Vanessa , Hughes Gill , Laddie Jo , Logun Angela , Malam Eve , Marshall Steve , Maynard Linda , McCormack Andrina , McKeating Catriona , Meates Lis , Murtagh Fliss , Namisango Eve , Neefjes Veronica , Norman Cheryl , Picton Sue , Ramsenthaler Christina , Roach Anna , Smith Ellen , Ward Michelle , Whiting Mark 
Published: July 2023

Abstract
Background
Person-centred outcome measures (PCOMs) are commonly used in routine adult healthcare to measure and improve outcomes, but less attention has been paid to PCOMs in children’s services. The aim of this systematic review is to identify and synthesise existing evidence of the determinants, strategies, and mechanisms that influence the implementation of PCOMs into paediatric healthcare practice.

Methods
The review was conducted and reported in accordance with PRISMA guidelines. Databased searched included CINAHL, Embase, Medline, and PsycInfo. Google scholar was also searched for grey literature on 25th March 2022. Studies were included if the setting was a children’s healthcare service, investigating the implementation or use of an outcome measure or screening tool 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 (CFIR). Results were presented as a narrative synthesis, and a logic model developed.

Results
We retained 69 studies, 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 measure implementation included staff lack of knowledge about how the measure may improve care and outcomes; the complexity of using and implementing the measure; and a lack of resources to support implementation and its continued use including funding and staff. The most frequently reported facilitators of implementation and continued use include educating and training staff and families on: how to implement and use the measure; the advantages of using PCOMs over current practice; and the benefit their use has on patient care and outcomes. The resulting logic model presents the mechanisms through which strategies can reduce the barriers to implementation and support the use of PCOMs in practice.

Conclusions
These findings can be used to support the development of context-specific implementation plans through a combination of existing strategies. This will enable the implementation of PCOMs into routine paediatric healthcare practice to empower settings to better identify and improve child-centred outcomes.

Trial registration
Prospero CRD 42022330013.