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Author Notes:

Asya Agulnik, asya.agulnik@stjude.org

AA, DG developed the idea. MP-T, SG, PE, HM-T, AG-R, MA, CB, ZC, CH, MJ, JJL, AM, EM, EPe, EPi collected the data. AA provided supervision. FA and AA conducted the data analyses. FA, AA, DG drafted manuscript and prepared the tables and figures. All authors contributed to the interpretation of the findings, the editing of the article, and the approval of the final submitted version.

We thank the PEWS implementation teams at all Proyecto EVAT centers, including those who participated in this study, Marcela Hill for the figure design, and the Proyecto EVAT Steering Committee for oversight of this work

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Research Funding:

This study was funded by the American Lebanese-Syrian Associated Charities (ALSAC). AA was funded by the Conquer Cancer Foundation Global Oncology Young Investigator Award for this work. FA was funded through the St. Jude Children’s Research Hospital Pediatric Oncology Education Program via grant R25CA23944 from the National Cancer Institute. These funders were not involved in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Keywords:

  • Pediatric Early Warning Systems (PEWS)
  • global health
  • implementation science
  • pediatric oncology
  • quality improvement collaborative (QIC)
  • resource-limited settings

Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals

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Journal Title:

Frontiers in Oncology

Volume:

Volume 13

Publisher:

, Pages 1122355-1122355

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: Pediatric Early Warning Systems (PEWS) aid in identification of deterioration in hospitalized children with cancer but are underutilized in resource-limited settings. Proyecto EVAT is a multicenter quality improvement (QI) collaborative in Latin America to implement PEWS. This study investigates the relationship between hospital characteristics and time required for PEWS implementation. Methods: This convergent mixed-methods study included 23 Proyecto EVAT childhood cancer centers; 5 hospitals representing quick and slow implementers were selected for qualitative analysis. Semi-structured interviews were conducted with 71 stakeholders involved in PEWS implementation. Interviews were recorded, transcribed and translated to English, then coded using a priori and novel codes. Thematic content analysis explored the impact of hospital characteristics and QI experience on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time. Results: In both quantitative and qualitative analysis, material and human resources to support PEWS significantly impacted time to implementation. Lack of resources produced various obstacles that extended time necessary for centers to achieve successful implementation. Hospital characteristics, such as funding structure and type, influenced PEWS implementation time by determining their resource-availability. Prior hospital or implementation leader experience with QI, however, helped facilitate implementation by assisting implementers predict and overcome resource-related challenges. Conclusions: Hospital characteristics impact time required to implement PEWS in resource-limited childhood cancer centers; however, prior QI experience helps anticipate and adapt to resource challenges and more quickly implement PEWS. QI training should be a component of strategies to scale-up use of evidence-based interventions like PEWS in resource-limited settings.

Copyright information:

© 2023 Abutineh, Graetz, Muniz-Talavera, Ferrara, Puerto-Torres, Chen, Gillipelli, Elish, Gonzalez-Ruiz, Alfonso Carreras, Alvarez, Arce Cabrera, Arguello Vargas, Armenta Cruz, Barra, Calderon Sotelo, Carpio, Chavez Rios, Covarrubias, de Leon Vasquez, Diaz Coronado, Fing Soto, Gomez-Garcia, Hernandez, Juarez Tobias, Leon, Loeza Oliva, Mendez, Miller, Montalvo Cozar, Negroe Ocampo, Penafiel, Pineda, Rios, Rodriguez Ordonez, Soto Chavez, Devidas and Agulnik

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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