Pediatric Randomized Clinical Trials in Community Hospitals: Strategies to Enhance Site Participation and Engagement

Community hospitals provide the majority of inpatient pediatric care in the United States but face significant barriers to conducting research. More equitable research participation across the spectrum of hospital types that deliver inpatient pediatric care can improve pediatric care quality and generalizability of research findings. Thus, we sought to identify strategies to promote community hospital participation in pediatric randomized clinical trials (RCTs).

We convened an interdisciplinary group of 33 panelists with expertise across clinical roles (eg, physicians, nurses), nonclinical partners (eg, parents, clinical trialists), and practice environments (eg, children's and community hospitals). We conducted 2 rounds of consensus building using the nominal group technique. Panelists brainstormed, discussed, and scored strategies in each round. Round 1 was conducted within small groups to broadly identify potential strategies. Round 2 was conducted as a large group to refine and rescore top strategies. We performed descriptive analyses of scores and qualitative content analysis of identified strategies (including member checking).

Panelists identified 119 ideas in round 1. The 20 highest scoring ideas from round 1 were presented in round 2, where 19 strategies were scored then refined into 14 specific strategies. We identified 3 overarching domains: (1) policy changes in funding prioritization and scientific review guidelines, (2) systems for providing centralized resources, and (3) research design and planning tailored to community hospital participation.

We identified 14 strategies for supporting the conduct of pediatric RCTs in community hospitals. Implementing these strategies will require structural changes to RCT design and recruitment for hospitals, funders, and investigators.