OBJECTIVE This systematic review examines the facilitators and barriers to the use of patient reported outcome measures (PROMs) in outpatient rehabilitation settings and provides strategies to improve care to maximize patient outcomes. DATA SOURCES Eleven databases were systematically searched from November 2018 to May 2019. STUDY SELECTION Two reviewers independently assessed articles based on the following inclusion criteria: English text, articles evaluating barriers and facilitators, include PROMs, and occur in an outpatient rehabilitation setting (physical therapy, occupational therapy, speech language pathology, or athletic training). Of the 10,164 articles initially screened, 15 articles were included in this study. DATA EXTRACTION Data was extracted from the selected articles by two independent reviewers and put into an extraction template and into the Consolidated Framework for Implementation Research (CFIR) model. The Appraisal Tool for Cross Sectional Studies (AXIS) was conducted on each study to assess study design, risk of bias, and reporting quality of the eligible studies. DATA SYNTHESIS Ten studies were identified as high quality, according to the AXIS. Based on the CFIR model, the top barriers identified focused on clinician training and time in the implementation process, lack of recognized value and knowledge at the individual level, lack of access and support in the inner setting, and inability of patients to complete PROMs in the intervention process. Facilitators were identified as education in the implementation process, support and availability of PROMs in the inner setting and recognized value at the individual level. CONCLUSION More barriers than facilitators have been identified which is consistent with PROM underutilization. Clinicians and administrators should find opportunities to overcome the barriers identified and leverage the facilitators to improve routine PROM use and maximize patient outcomes.

中文翻译：

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在门诊康复环境中实施患者报告的结果措施：使用实施研究综合框架对促进因素和障碍进行系统审查。

目标 本系统评价检查了在门诊康复环境中使用患者报告结果测量 (PROM) 的促进因素和障碍，并提供了改善护理以最大化患者结果的策略。数据来源 从 2018 年 11 月至 2019 年 5 月，系统搜索了 11 个数据库。 研究选择 两位评论员根据以下纳入标准独立评估文章：英文文本、评估障碍和促进因素的文章、包括 PROM 和发生在门诊康复环境（物理治疗） 、职业治疗、语言病理学或运动训练）。在最初筛选的 10,164 篇文章中，15 篇被纳入本研究。数据提取 由两名独立审查员从所选文章中提取数据，并将其放入提取模板和实施研究综合框架 (CFIR) 模型中。对每项研究进行横断面研究评估工具 (AXIS)，以评估研究设计、偏倚风险和合格研究的报告质量。数据综合 根据 AXIS，十项研究被确定为高质量。根据 CFIR 模型，确定的主要障碍集中在临床医生的培训和实施过程中的时间、个人层面缺乏公认的价值和知识、内部环境中缺乏访问和支持以及患者无法完成 PROM干预过程。促进者被确定为实施过程中的教育者，内部环境中 PROM 的支持和可用性以及个人层面的公认价值。结论 已经确定了比促进因素更多的障碍，这与 PROM 未充分利用是一致的。临床医生和管理人员应寻找机会克服已确定的障碍，并利用促进者来改进常规 PROM 的使用并最大限度地提高患者的治疗效果。