Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in low-resource hospitals

在资源匮乏的医院中识别临床恶化并提高儿童癌症生存率的干预措施的可持续性决定因素

• 批准号: 10562780
• 负责人: Asya Agulnik
• 金额: $ 68.24万
• 依托单位: ST. JUDE CHILDREN'S RESEARCH HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10562780
• 关键词: Address; Administrator; Admission activity; Adopted; Adoption; Cessation of life; Childhood; Clinical; Country; Deterioration; Early identification; Equity; Evaluation; Evidence based intervention; Face; Failure; Focus Groups; Goals; Health; Hospitalized Child; Hospitals; Individual; Intervention; Investments; Knowledge; Latin American; Leadership; Malignant Childhood Neoplasm; Maps; Measurement; Mentors; Methods; Modernization; Monitor; Nurses; Outcome; Patient-Focused Outcomes; Patients; Pediatric Oncology; Phase; Predictive Factor; Registries; Resource-limited setting; Resources; Saint Jude Children' s Research Hospital; Standardization; Supportive care; Surveys; System; Testing; Time; Toxic effect; Training; Universities; Washington; Work; cancer care; cancer survival; cancer therapy; cohort; design; evidence base; health equity; implementation intervention; implementation process; implementation science; improved; improved outcome; innovation; longitudinal, prospective study; mortality; novel; novel strategies; organizational readiness; prevent; preventable death; prospective; wasting

PROJECT SUMMARY/ABSTRACT Background and Goal. More than 90% of children with cancer live in low-resourced settings, where survival is only 20%. Sustainable evidence-based (EB) interventions yielding ongoing beneficial patient outcomes is critical to improve childhood cancer survival. A better understanding of factors promoting intervention sustainability in these settings is urgently needed. The goal of our project is to provide an empirical understanding of how clinical capacity, or the resources needed to sustain an intervention, impacts sustainment of a Pediatric Early Warning System (PEWS), EB interventions that improves pediatric oncology outcomes in low-resource hospitals by quickly detecting clinical deterioration in children with cancer, preventing the need for more intense treatment. Aims and Methods: We will conduct a prospective, longitudinal study of 92 low-resource hospitals implementing and sustaining PEWS. This work will build on an ongoing St. Jude-Wash U Implementation Science Collaborative and Proyecto EVAT, a quality improvement collaborative of Latin American pediatric oncology centers. Aim 1: We will evaluate how clinical capacity for sustainability changes over time through 5 to 9 prospective measurements of capacity via survey of clinical staff using PEWS (n=13 per center) during the phases of PEWS adoption, implementation, and sustainability. Aim 2: We will determine the relationship between capacity and a) PEWS sustainment and b) clinical deterioration mortality among pediatric oncology patients at centers sustaining PEWS for 2 to 10 years using chart review and an existing patient outcomes registry. Aim 3: We will develop novel strategies to promote sustainability by gaining a deeper understanding of perceived challenges to building capacity and PEWS sustainment. In combination with quantitative outcomes, we will conduct 24 focus groups with hospital staff (doctors, nurses, and administrators) from hospitals with both high (n=4) and low capacity (n=4). We will then use implementation mapping to generate theoretically driven, empirically-supported strategies which promote sustainability. All aims will be informed by an External Advisory Board and the EVAT steering committee. Innovation and Impact: Few EB sustainability strategies exist for low-resource settings. This study will advance implementation science by providing a theoretically-driven, foundational understanding of factors that predict sustainability among a large, diverse cohort of low-resource hospitals. We will then use this knowledge to develop sustainability strategies that optimize capacity and promote long- term sustainment of PEWS and improvements in patient outcomes in low-resource settings - ultimately promoting equity in childhood cancer care globally.

项目摘要/摘要 背景和目标。超过90％的癌症儿童生活在低资源的环境中 生存只有20％。可持续的循证（EB）干预措施产生持续有益的 患者预后对于改善儿童癌症的存活至关重要。更好地理解因素 迫切需要在这些环境中促进干预可持续性。我们项目的目标是 提供对临床能力或维持所需资源的经验理解 干预，影响小儿预警系统（PEWS）的维持，EB干预措施 通过快速检测到临床 癌症儿童的恶化，阻止了需要更激烈的治疗。 目的和方法：我们将对92家低资源医院进行预期的纵向研究 实施和维持长椅。这项工作将建立在正在进行的圣裘德洗礼的基础上 实施科学协作和Proyecto evat，质量改进合作 拉丁美洲儿科肿瘤学中心。目标1：我们将评估临床能力 可持续性随时间变化，直至5到9个预期的能力测量，通过调查 在采用长椅的阶段，使用长椅（n = 13个中心）的临床人员采用，实施， 和可持续性。目标2：我们将确定能力与a）长椅之间的关系 维持和b）中心儿科肿瘤患者的临床恶化死亡率 使用图表审查和现有的患者结果注册表来维持2至10年的长椅。目的 3：我们将通过更深入地了解 认为建立能力和座位维持的挑战。结合定量 结果，我们将与医院工作人员（医生，护士和管理人员）进行24个焦点小组 来自高容量和低容量（n = 4）的医院。然后，我们将使用实施映射 产生理论上驱动的，经验支持的策略，以促进可持续性。全部 AIMS将由外部顾问委员会和EVAT指导委员会告知。 创新和影响：低资源环境的EB可持续性策略很少。这项研究会 通过提供理论驱动的基础理解，提前实施科学 预测大量低资源医院可持续性的因素。我们将 然后使用这些知识来制定可持续性策略，以优化能力并促进长期 长椅的期限维持和在低资源环境中的患者预后改善 - 最终在全球范围内促进儿童癌症护理的公平。