Why Core Outcome Sets Do Not Get Used—And How Dissemination and Implementation Science can Help

Introduction: Core outcome sets (COSs) are standardized, consensus-based sets of outcomes that should be measured and reported in all studies of a specific condition. They offer a structured approach to outcome reporting and improve trial comparability and ensure that outcomes reflect stakeholder priorities. Despite increasing development efforts, most COSs fail to reach routine use in trials, registries, and clinical workflows.The objective of the study was to propose a conceptual implementation framework, rooted in dissemination and implementation (D&I) science, for improving the adoption of COS in surgical research. This framework is prospectively applied to an emerging COS for peripheral nerve injury (PNI) as a case example. Methods: We integrate three complementary D&I tools: Consolidated Framework for Implementation Research, the Expert Recommendations for Implementing Change taxonomy, and Reach, Effectiveness, Adoption, Implementation, Maintenance. These tools guide planning, barrier identification, and strategy selection for COS uptake. A newly developed COS for PNI serves as a case example. Results: We outline a structured approach to COS implementation: (1) Consolidated Framework for Implementation Research identifies contextual barriers (e.g., workflow burden, infrastructure gaps); (2) Expert Recommendations for Implementing Change offers actionable strategies such as champion engagement, electronic health record integration, and audit-feedback loops; and (3) Reach, Effectiveness, Adoption, Implementation, Maintenance provides metrics to evaluate uptake and sustainability. Early implementation of the PNI COS will involve REDCap-based data capture, pilot fidelity tracking, and feedback-informed revisions. Conclusions: To close the implementation gap, COS developers and surgical teams must embed D&I strategies from the outset. Our framework offers a generalizable path for COS adoption in complex surgical environments and highlights the need for future research on tailored implementation approaches across subspecialties.