학술논문
Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals
Document Type
article
Author
Farris Abutineh; Dylan E. Graetz; Hilmarie Muniz-Talavera; Gia Ferrara; Maria Puerto-Torres; Yichen Chen; Srinithya R. Gillipelli; Paul Elish; Alejandra Gonzalez-Ruiz; Yvania Alfonso Carreras; Shillel Alvarez; Daniela Arce Cabrera; Deiby Arguello Vargas; Miriam Armenta Cruz; Camila Barra; Patricia Calderon Sotelo; Zulma Carpio; Mayra Chavez Rios; Daniela Covarrubias; Lucy de Leon Vasquez; Rosdali Diaz Coronado; Ever Amilcar Fing Soto; Wendy Gomez-Garcia; Cinthia Hernandez; María Susana Juarez Tobias; Esmeralda Leon; Jose de Jesus Loeza Oliva; Alejandra Mendez; Kenia Miller; Erika Montalvo Cozar; Natalia del Carmen Negroe Ocampo; Eulalia Penafiel; Estuardo Pineda; Ligia Rios; Esperanza Rodriguez Ordonez; Veronica Soto Chavez; Meenakshi Devidas; Asya Agulnik
Source
Frontiers in Oncology, Vol 13 (2023)
Subject
Language
English
ISSN
2234-943X
Abstract
BackgroundPediatric 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.MethodsThis 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.ResultsIn 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.ConclusionsHospital 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.