Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings

Descripción del Articulo

Importance: Pediatric early warning systems (PEWS) aid with early identification of clinical deterioration and improve outcomes in children with cancer hospitalized in resource-limited settings
Detalles Bibliográficos
Autores: Agulnik, Asya, Ferrara, Gia, Puerto-Torres, María, Gillipelli, SR, Elish, Paul, Muniz-Talavera, Hilmarie, Gonzalez-Ruiz, A, Armenta, M, Barra, C, Diaz, R, Hernandez, C, Juarez Tobias, S, De Jesus Loeza, J, Mendez, A, Montalvo, E, Penafiel, E, Pineda, E, Graetz, DE
Formato: artículo
Fecha de Publicación:2022
Institución:Instituto Nacional de Enfermedades Neoplásicas
Repositorio:INEN-Institucional
Lenguaje:inglés
OAI Identifier:oai:repositorio.inen.sld.pe:20.500.14703/261
Enlace del recurso:https://hdl.handle.net/20.500.14703/261
Nivel de acceso:acceso abierto
Materia:Barriers
Pediatric
Resource-Limited Settings
https://purl.org/pe-repo/ocde/ford#3.02.21
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dc.title.none.fl_str_mv Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
title Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
spellingShingle Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
Agulnik, Asya
Barriers
Pediatric
Resource-Limited Settings
https://purl.org/pe-repo/ocde/ford#3.02.21
title_short Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
title_full Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
title_fullStr Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
title_full_unstemmed Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
title_sort Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
author Agulnik, Asya
author_facet Agulnik, Asya
Ferrara, Gia
Puerto-Torres, María
Gillipelli, SR
Elish, Paul
Muniz-Talavera, Hilmarie
Gonzalez-Ruiz, A
Armenta, M
Barra, C
Diaz, R
Hernandez, C
Juarez Tobias, S
De Jesus Loeza, J
Mendez, A
Montalvo, E
Penafiel, E
Pineda, E
Graetz, DE
author_role author
author2 Ferrara, Gia
Puerto-Torres, María
Gillipelli, SR
Elish, Paul
Muniz-Talavera, Hilmarie
Gonzalez-Ruiz, A
Armenta, M
Barra, C
Diaz, R
Hernandez, C
Juarez Tobias, S
De Jesus Loeza, J
Mendez, A
Montalvo, E
Penafiel, E
Pineda, E
Graetz, DE
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Agulnik, Asya
Ferrara, Gia
Puerto-Torres, María
Gillipelli, SR
Elish, Paul
Muniz-Talavera, Hilmarie
Gonzalez-Ruiz, A
Armenta, M
Barra, C
Diaz, R
Hernandez, C
Juarez Tobias, S
De Jesus Loeza, J
Mendez, A
Montalvo, E
Penafiel, E
Pineda, E
Graetz, DE
dc.subject.none.fl_str_mv Barriers
Pediatric
Resource-Limited Settings
topic Barriers
Pediatric
Resource-Limited Settings
https://purl.org/pe-repo/ocde/ford#3.02.21
dc.subject.ocde.none.fl_str_mv https://purl.org/pe-repo/ocde/ford#3.02.21
description Importance: Pediatric early warning systems (PEWS) aid with early identification of clinical deterioration and improve outcomes in children with cancer hospitalized in resource-limited settings
publishDate 2022
dc.date.accessioned.none.fl_str_mv 2025-01-02T14:42:02Z
dc.date.available.none.fl_str_mv 2025-01-02T14:42:02Z
dc.date.issued.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
dc.type.version.none.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.doi.none.fl_str_mv 10.1001/jamanetworkopen.2022.1547
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.14703/261
dc.identifier.journal.none.fl_str_mv JAMA Network Open
identifier_str_mv 10.1001/jamanetworkopen.2022.1547
JAMA Network Open
url https://hdl.handle.net/20.500.14703/261
dc.language.iso.none.fl_str_mv eng
language eng
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
dc.rights.uri.none.fl_str_mv https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/4.0/
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv American Medical Association
dc.publisher.country.none.fl_str_mv US
publisher.none.fl_str_mv American Medical Association
dc.source.none.fl_str_mv reponame:INEN-Institucional
instname:Instituto Nacional de Enfermedades Neoplásicas
instacron:INEN
instname_str Instituto Nacional de Enfermedades Neoplásicas
instacron_str INEN
institution INEN
reponame_str INEN-Institucional
collection INEN-Institucional
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spelling PublicationAgulnik, AsyaFerrara, GiaPuerto-Torres, MaríaGillipelli, SRElish, PaulMuniz-Talavera, HilmarieGonzalez-Ruiz, AArmenta, MBarra, CDiaz, RHernandez, CJuarez Tobias, SDe Jesus Loeza, JMendez, AMontalvo, EPenafiel, EPineda, EGraetz, DE2025-01-02T14:42:02Z2025-01-02T14:42:02Z202210.1001/jamanetworkopen.2022.1547https://hdl.handle.net/20.500.14703/261JAMA Network OpenImportance: Pediatric early warning systems (PEWS) aid with early identification of clinical deterioration and improve outcomes in children with cancer hospitalized in resource-limited settingshowever, there may be barriers to implementation. Objective: To evaluate stakeholder-reported barriers and enablers to PEWS implementation in resource-limited hospitals. Design, Setting, and Participants: In this qualitative study, semistructured stakeholder interviews were conducted at 5 resource-limited pediatric oncology centers in 4 countries in Latin America. Hospitals participating in a multicenter collaborative to implement PEWS were purposefully sampled based on time required for implementation (fast vs slow), and stakeholders interviewed included physicians, nurses, and administrators, involved in PEWS implementation. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted virtually in Spanish, audiorecorded, and professionally transcribed and translated into English. A codebook was developed a priori using the CFIR and supplemented with codes inductively derived from transcript review. Two coders independently analyzed all transcripts, achieving a κ of 0.8 to 0.9. The study was conducted from June 1 to August 31, 2020. Main Outcomes and Measures: Thematic analysis was conducted based on CFIR domains (inner setting, characteristics of individuals, outer setting, intervention characteristics, and implementation process) to identify barriers and enablers to PEWS implementation. Results: Seventy-one staff involved in PEWS implementation were interviewed, including 32 physicians (45%), 32 nurses (45%), and 7 administrators (10%). Of these, 50 were women (70%). Components of the 5 CFIR domains were mentioned by participants as barriers and enablers to PEWS implementation at both fast- and slow-implementing centers. Participants emphasized barriers at the level of the clinical staff, hospital, external factors, and PEWS intervention. These barriers included staff resistance to change, inadequate resources, components of health systems, and the perceived origin and complexity of PEWS. At all centers, most barriers were successfully converted to enablers during the implementation process through targeted strategies, such as early stakeholder engagement and adaptation, including adapting PEWS to better fit the local context and changing the hospital setting to support ongoing use of PEWS. Conclusions and Relevance: To date, this is the first multicenter, multinational study describing barriers and enablers to PEWS implementation in resource-limited settings. Findings suggest that many barriers are not immutable and can be converted to enablers during the implementation process. This work can serve as a guide for clinicians looking to implement evidence-based interventions to reduce global disparities in patient outcomes. © 2020 Armand Colin. All rights reserved.application/pdfengAmerican Medical AssociationUSinfo:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/4.0/BarriersPediatricResource-Limited Settingshttps://purl.org/pe-repo/ocde/ford#3.02.21Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settingsinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionreponame:INEN-Institucionalinstname:Instituto Nacional de Enfermedades Neoplásicasinstacron:INENORIGINALAgulnik, Asya; 2022application/pdf1048751https://repositorio.inen.sld.pe/backend/api/core/bitstreams/6ce50e35-7006-40bf-9f11-28a805da55f7/downloadf168f50919d94eb039f48cce6cae93beMD51trueAnonymousREADTEXTAgulnik, Asya; 2022.txtWritten by FormatFilter org.dspace.app.mediafilter.TikaTextExtractionFilter on 2025-03-29T20:39:03Z (GMT).Extracted texttext/plain72515https://repositorio.inen.sld.pe/backend/api/core/bitstreams/b5167fb1-ad1f-41ec-8cf0-f3ffef88719d/downloadba6404aa7caf84e23f5a3657fa7e67e1MD54falseAnonymousREADTHUMBNAILAgulnik, Asya; 2022.jpgWritten by FormatFilter org.dspace.app.mediafilter.PDFBoxThumbnail on 2025-03-29T20:39:03Z (GMT).Generated Thumbnailimage/jpeg42927https://repositorio.inen.sld.pe/backend/api/core/bitstreams/776bb4f9-4042-41af-9d33-2e0140b13665/downloadb416a23eb82015c38d2b1ac9cea30cbbMD55falseAnonymousREAD20.500.14703/261oai:repositorio.inen.sld.pe:20.500.14703/2612026-02-17T14:39:36.303Zhttps://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessopen.accesshttps://repositorio.inen.sld.peRepositorio del Instituto Nacional de Enfermedades Neoplásicasrepositorio@inen.sld.pe
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Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
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