Abstract / Summary
The Extension for Community Healthcare Outcomes (ECHO) model has emerged as a key strategy for improving specialist access and addressing workforce shortages in decentralised healthcare. While widely assessed in adult care, its use in paediatrics has been inconsistently reported. This systematic review examined how paediatric ECHO programs have been implemented using Proctor et al’s outcomes framework. A systematic search of MEDLINE, Embase and Web of Science was conducted from inception to 21 May 2025 without language restrictions. Eligible studies included empirical evaluations of paediatric ECHO programs reporting implementation outcomes. Two reviewers independently screened records and extracted data. Study quality was assessed using the Mixed Methods Appraisal Tool and findings were synthesised narratively. A total of 55 studies met the inclusion criteria and were included in the synthesis. Most used descriptive or mixed methods designs, with quality assessment identifying common limitations relating to confounding, sampling and mixed methods integration. Evidence for early implementation outcomes was strong, with feasibility reported as high in 48 (87%) studies, acceptability in 33 (60%), adoption in 29 (53%) and appropriateness in all 55 (100%). Later outcomes were assessed as high much less frequently, with fidelity examined as high in five (9%) studies, penetration in 18 (33%), sustainability in 12 (22%) and cost as high in no studies. Higher performing programs often incorporated structured formats, interactive case discussions and institutional support. Sex and gender were not consistently reported and methodological quality varied. ECHO is a practical and effective approach for strengthening paediatric services, with consistent evidence of feasibility, acceptability and appropriateness. Limited evaluation of fidelity, penetration, sustainability and cost restricts understanding of long-term impact. Embedding standardised assessments of these outcomes in future programs is essential to support evidence-based planning and scalable implementation. Not applicable