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Innovations in Data-Driven Approaches to Improve Sepsis Care for Children in Low-Resource Settings (presentations) ~ QI
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Chandna, Arjun; Akech, Samuel; Kortz, Teresa B.; Wiens, Matthew O. — 2022-11-16 In November 2022, the Centre for International Child Health (CICH) at BC Children's Hospital brought together leading young researchers at the <a href = "https://www.astmh.org/annual-meeting/2022e-reg">2022 American Society for Tropical Medicine and Hygiene Annual Meeting</a> to share their work developing leveraging frugal digital technology and data-driven vulnerability prediction to improve care across different points of a critically-ill child’s journey. Panelists described development and validation of risk prediction models, highlighting how such models can guide targeted, affordable interventions. Attendees had a chance to learn how practical and affordable digital technology equipped with clinical algorithms can support health workers with identifying, treating, and following-up high-risk children, improving outcomes within health facilities and at home, and the role of promising new host and pathogen biomarkers in enhancing the predictive capability of prognostic models.<br /> <br /><strong>Speakers: </strong><br /> <br />Arjun Chandna: Risk stratification of pediatric febrile illness to inform effective community management and earlier referral to higher-level care.<br /> <br />Samuel Akech: Smart Triage, a prediction-based facility quality improvement program for critically ill children.<br /> <br />Teresa Kortz: Point-of-care biomarkers for mortality risk stratification in pediatric severe febrile illness; using next-generation sequencing for etiology of severe febrile illness<br /> <br />Matthew Wiens: Smart Discharges, post-discharge interventions based on the risk of post-discharge mortality.<br /> <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator on <a href = "https://www.bcchr.ca/pediatric-sepsis-data-colab">this page</a> under "collaborate with the pediatric sepsis colab."
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Smart Discharges Program for children with sepsis in Uganda: a qualitative program evaluation
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Wiens, Matthew O.; Jacob, Shevin T.; Kabajaasi, Olive; Kenya Mugisha, Nathan — 2024-07-22 <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>. <br /><strong>Background:</strong> Pediatric sepsis continues to be a significant burden in low- and middle-income countries. Studies have shown that in-hospital mortality is equal to, and sometimes exceeds, mortality during the post-discharge period. These facts call for a concerted action to improve childhood survival following discharge from sepsis. The Smart Discharges Program uses a mobile health platform for risk stratification of children admitted with sepsis to target at-risk children and their caregivers for educational counseling at discharge and referrals and follow-up care during the vulnerable post-discharge period. Since 2017, this program has been enrolling children at four hospitals in Uganda (Mbarara, Masaka and Jinja Regional Referral Hospitals and Holy Innocents Children’s Hospital). However, the perceptions of the caregivers with regard to the SD Program are poorly understood. <br /> <br /><strong>Objectives:</strong> The purpose of the study is to explore the parents’/caregivers’ perceptions of the Smart Discharges Program in regard to its contribution to improved care post-discharge of children who have suffered from severe infections. Specific objectives include i) to describe parents'/caregivers' experiences receiving and using Smart Discharges care package; ii) to explore parents'/caregivers' perception of the barriers to access the care provided by Smart Discharges; and iii) to document the lessons learned and opportunities for improvement of Smart Discharges Program to improve discharge care for children who have suffered from sepsis. <br /> <br /><strong>Methods:</strong> A qualitative design using different approaches and methods will be adopted. We will enrol 64 parents/caregivers of children who have received care through the Smart Discharges Program and 8 implementation nurses involved in providing the care in this program at the four program sites. Seventy-two participants (64 parents/caregivers and 8 nurses) will take part in the study. Eight Focus Group Discussions (8 participants per FGD), and 8 interviews with program implementation nurses will be conducted. Audio files will be transcribed verbatim, translated into English and analyzed using Nvivo. Findings will contribute to improvement of post-discharge care in Uganda.<br /> <br /><strong>Ethics Declaration:</strong> We will obtain ethics approval from the University of British Columbia Children’s & Women’s Research Ethics Board in Canada as well as the relevant institutional review boards in Uganda. Administrative clearance will also be obtained from the respective hospitals. <br />
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Caregivers’ and nurses’ perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative study
Borealis
Behan, Justine; Kabajaasi, Olive; Derksen, Brooklyn; Sendegye, George; Kuugumikiriza; Komugisha, Clare; Sundararajan, Radhika; Jacob, Shevin T.; Kenya-Mugisha, Nathan; Wiens, Matthew O. — 2024-10-24 <strong>Background:</strong> Sepsis arises when the body’s response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program’s effect on post-discharge care. <br> <br><strong>Methods:</strong> We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. <br/> <br><strong>Findings:</strong> Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.<br/> <br><strong>Data Collection Methods:</strong> Facilitators of the same sex as the participants moderated the FGDs in the local language. Individual interviews with nurses were conducted by a social scientist in English. A focus group discussion guide and a semi-structured interview guide were used to provide structure and consistency to the discussion/interviews while allowing for novel concepts to be shared. Topics in the interview and FGD guides were developed by senior investigators who have expertise in the field of pediatric sepsis. The FDG guides focused on experiences at the admitting facility, experiences after discharge, processes involving referral for post-discharge clinical care, and barriers to post-discharge care. Interview guides focused on the experience of providing caregiver education and counselling, and reporting of which programmatic components worked well and did not work well. Nurse interviewees were also asked about their observations of the benefits and challenges of the program to the caregivers. Due to budget and logistical constraints, the FGD and interview guides were not pre-tested prior to use and no repeat interviews were done. FGDs and interviews were audio recorded and transcribed directly in English by a professional translator and then reviewed for accuracy and consistency. Using a thematic analysis approach, initial open coding of transcripts was done by two investigators. During analysis, data was organized using NVivo version 12.0 (QSR, Massachusetts, United States). After development of the coding framework and initial coding, themes were proposed, and discussed between three investigators who jointly agreed on the study themes and then confirmed full team agreement on the final themes. <br/> <br><strong>Ethics Declaration:</strong> Ethical approval was obtained from the the Makerere University School of Public Health, Research and Ethics Committee (SPH-REC # 691) and the Uganda National Council for Science and Technology (UNCST SS #5047). <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

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(Author: Wiens, Matthew O.)

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