Abutineh Farris, Graetz Dylan E, Muniz-Talavera Hilmarie, Ferrara Gia, Puerto-Torres Maria, Chen Yichen, Gillipelli Srinithya R, Elish Paul, Gonzalez-Ruiz Alejandra, Alfonso Carreras Yvania, Alvarez Shillel, Arce Cabrera Daniela, Arguello Vargas Deiby, Armenta Cruz Miriam, Barra Camila, Calderon Sotelo Patricia, Carpio Zulma, Chavez Rios Mayra, Covarrubias Daniela, de Leon Vasquez Lucy, Diaz Coronado Rosdali, Fing Soto Ever Amilcar, Gomez-Garcia Wendy, Hernandez Cinthia, Juarez Tobias María Susana, Leon Esmeralda, Loeza Oliva Jose de Jesus, Mendez Alejandra, Miller Kenia, Montalvo Cozar Erika, Negroe Ocampo Natalia Del Carmen, Penafiel Eulalia, Pineda Estuardo, Rios Ligia, Rodriguez Ordonez Esperanza, Soto Chavez Veronica, Devidas Meenakshi, Agulnik Asya
Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States.
Baylor College of Medicine, Houston, TX, United States.
Front Oncol. 2023 May 3;13:1122355. doi: 10.3389/fonc.2023.1122355. eCollection 2023.
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.
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 and novel codes. Thematic content analysis explored the impact of and on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time.
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.
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.
儿科早期预警系统（PEWS）有助于识别住院癌症患儿的病情恶化情况，但在资源有限的环境中未得到充分利用。Proyecto EVAT是拉丁美洲一个实施PEWS的多中心质量改进（QI）协作项目。本研究调查了医院特征与PEWS实施所需时间之间的关系。
这项融合性混合方法研究包括23个Proyecto EVAT儿童癌症中心；选择了5家代表快速和缓慢实施者的医院进行定性分析。对71名参与PEWS实施的利益相关者进行了半结构化访谈。访谈进行了录音、转录并翻译成英文，然后使用[具体编码方法]和新代码进行编码。主题内容分析探讨了[相关因素]对PEWS实施所需时间的影响，并辅以定量分析，以探索医院特征与实施时间之间的关系。
在定量和定性分析中，支持PEWS的物质和人力资源对实施时间有显著影响。资源匮乏产生了各种障碍，延长了各中心实现成功实施所需的时间。医院特征，如资金结构和类型，通过决定其资源可用性来影响PEWS的实施时间。然而，医院或实施领导者先前的QI经验通过帮助实施者预测和克服与资源相关的挑战，有助于促进实施。
医院特征影响在资源有限的儿童癌症中心实施PEWS所需的时间；然而，先前的QI经验有助于预测和适应资源挑战，并更快地实施PEWS。QI培训应成为在资源有限环境中扩大使用PEWS等循证干预措施的战略组成部分。
