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.

项目总结/摘要 背景和目标。超过90%的癌症儿童生活在资源匮乏的环境中， 存活率只有20%。可持续的循证干预措施持续产生效益 患者的预后对提高儿童癌症存活率至关重要。更好地理解因素 迫切需要在这些环境中促进干预措施的可持续性。我们项目的目标是 提供了一个经验性的了解如何临床能力，或所需的资源，以维持一个 干预，影响维持儿科早期预警系统（PEWS），EB干预， 通过快速检测临床症状，改善低资源医院的儿科肿瘤学结局 癌症儿童的病情恶化，防止需要更密集的治疗。 目的和方法：我们将对92家低资源医院进行前瞻性纵向研究 实施和维持PEWS。这项工作将建立在一个正在进行的圣犹大华盛顿大学 执行科学协作和Proyecto EVAT，一个质量改进协作， 拉丁美洲儿科肿瘤中心。目标1：我们将评估临床能力如何 可持续性随着时间的推移而变化，通过对能力的调查， 在PEWS采用、实施、 和可持续性。目标2：我们将确定容量与a）PEWS之间的关系 各中心儿科肿瘤患者的可持续性和B）临床恶化死亡率 使用病历审查和现有患者结局登记研究维持PEWS 2至10年。目的 3：我们将制定新的战略，通过更深入地了解 认识到能力建设和PEWS维持方面的挑战。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（n=4）和低容量（n=4）的医院。然后我们将使用实现映射 产生理论驱动的、有实践支持的战略，促进可持续发展。所有 目标将由外部咨询委员会和EVAT指导委员会提供信息。 创新和影响：很少有针对低资源环境的EB可持续发展战略。本研究将 通过提供理论驱动的基础理解来推进实施科学， 这些因素预测了大量不同的低资源医院队列的可持续性。我们将 然后利用这些知识制定可持续发展战略，优化能力，促进长期发展， 长期维持PEWS并改善低资源环境下的患者结局- 最终促进全球儿童癌症护理的公平性。