Document Type
Dissertation
Date of Degree
2-10-2026
Primary Advisor
Philip Van der Wees, PhD, PT
Keywords
Congenital heart disease; Adolescents; Developmental delays; Pediatric cardiology; Pediatric care units
Abstract
Background: High rates of developmental delays have been noted in children with congenital heart disease (CHD). Hospitalization and medical and surgical interventions in early childhood impact development. The Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program was created and implemented at one hospital to support the development of infants and toddlers with CHD in inpatient pediatric cardiac units. The CINCO program has been found to reduce delirium and improve cognitive outcomes for children with CHD.
Study Objectives: The aims of this study were to identify core components and implementation determinants of the CINCO program; explore how the CINCO program might be adapted for other inpatient pediatric cardiac centers; and determine the feasibility, acceptability, and appropriateness of the CINCO program from healthcare professionals’ perspectives.
Methods: This was a three-phase mixed methods study. In phase one, semi-structured interviews were conducted with healthcare professionals who originally designed and implemented the CINCO program to identify implementation determinants and key program components. During phase two, inpatient pediatric cardiac centers created interdisciplinary working groups that participated in 2-3 sessions via Zoom to adapt the CINCO program for their center. For phase three, healthcare professionals at each participating center from phase two provided feedback on adapted versions of CINCO generated during phase two. They completed an online questionnaire indicating the feasibility and importance of each pillar, and the feasibility, acceptability, and appropriateness of each adapted version of CINCO as a whole using the Feasibility of Intervention Measure (FIM), Acceptability of Intervention Measure (AIM), and Intervention Appropriateness Measure (IAM).
Results: During phase one, eight interviews revealed determinants affecting the CINCO program that related to all domains of the Consolidated Framework for Implementation Research (CFIR). Core program components included having all five pillars of the CINCO program, an interdisciplinary approach, developmental care rounds in-person at the bedside, specialized training for volunteers, a medical/nursing order set in the electronic medical record, and developmental care plans posted at the bedside. In phase two, five centers created interdisciplinary working groups of 5-9 healthcare professionals each. 53 unique adaptations to the CINCO program were generated, with the highest number (n=17) pertaining to the parent care and education pillar. In phase three, all five CINCO program pillars were rated more highly on importance than feasibility. The parent care and education pillar was highest in importance (mean=4.8, SD=0.4) and feasibility (mean=4.4, SD=0.6). AIM scores were highest (mean=18.2, SD=2.0), followed by IAM (mean=17.9, SD=2.2), then FIM scores (mean=16.8, SD=2.2).
Conclusion: The CINCO program can be easily customized to a range of inpatient pediatric cardiac centers while maintaining core components. Healthcare professionals find the CINCO program to be highly acceptable, appropriate, and feasible. Further research is needed to understand how the program could be adapted for low resource centers and centers located outside of the United States.
Recommended Citation
Hodgson, Sarah W., "Implementation of the Cardiac Inpatient Neurodevelopmental Care Optimization Program Across Pediatric Cardiac Inpatient Centers: A Mixed Methods Study" (2026). Doctor of Philosophy in Translational Health Sciences Dissertations. Paper 45.
https://hsrc.himmelfarb.gwu.edu/smhs_crl_dissertations/45
Open Access
1
Comments
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