Improvement in Pediatric Cardiac Surgical Outcomes Through Interhospital Collaboration

被引:62
作者
Gaies, Michael [1 ]
Pasquali, Sara K. [1 ]
Banerjee, Mousumi [2 ]
Dimick, Justin B. [3 ]
Birkmeyer, John D. [4 ]
Zhang, Wenying [5 ]
Alten, Jeffrey A. [6 ]
Chanani, Nikhil [7 ]
Cooper, David S. [6 ]
Costello, John M. [8 ]
Gaynor, J. William [9 ]
Ghanayem, Nancy [10 ]
Jacobs, Jeffrey P. [11 ]
Mayer, John E. [12 ]
Ohye, Richard G. [13 ]
Scheurer, Mark A. [8 ]
Schwartz, Steven M. [14 ,15 ]
Tabbutt, Sarah [16 ]
Charpie, John R. [1 ]
机构
[1] Univ Michigan, Sch Med, Dept Pediat, Ann Arbor, MI USA
[2] Univ Michigan, Sch Publ Hlth, Dept Biostat, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Sch Med, Dept Surg, Ann Arbor, MI USA
[4] Sound Phys, Tacoma, WA USA
[5] Univ Michigan, Ctr Hlth Outcomes & Policy, Ann Arbor, MI 48109 USA
[6] Univ Cincinnati, Coll Med, Dept Pediat, Cincinnati, OH USA
[7] Emory Univ, Sch Med, Dept Pediat, Atlanta, GA USA
[8] Med Univ South Carolina, Dept Pediat, Charleston, SC 29425 USA
[9] Univ Penn, Dept Surg, Perelman Sch Med, Philadelphia, PA 19104 USA
[10] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA
[11] Soc Thorac Surg, Chicago, IL USA
[12] Harvard Med Sch, Dept Cardiac Surg, Boston, MA 02115 USA
[13] Univ Michigan, Sch Med, Dept Cardiac Surg, Ann Arbor, MI USA
[14] Univ Toronto, Dept Pediat, Toronto, ON, Canada
[15] Univ Toronto, Dept Crit Care Med, Toronto, ON, Canada
[16] Univ Calif San Francisco, Sch Med, Dept Pediat, San Francisco, CA USA
基金
美国国家卫生研究院;
关键词
cardiac surgery; collaborative learning; congenital; outcomes; pediatric; quality; CONGENITAL HEART-SURGERY; SOCIETY; OPERATIONS; MODEL;
D O I
10.1016/j.jacc.2019.09.046
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Patients undergoing complex pediatric cardiac surgery remain at considerable risk of mortality and morbidity, and variation in outcomes exists across hospitals. The Pediatric Cardiac Critical Care Consortium (PC4) was formed to improve the quality of care for these patients through transparent data sharing and collaborative learning between participants. OBJECTIVES The purpose of this study was to determine whether outcomes improved over time within PC4. METHODS The study analyzed 19,600 hospitalizations (18 hospitals) in the PC4 clinical registry that included cardiovascular surgery from August 2014 to June 2018. The primary exposure was 2 years of PC4 participation; this provided adequate time for hospitals to accrue data and engage in collaborative learning. Aggregate case mix-adjusted outcomes were compared between the first 2 years of participation (baseline) and all months post-exposure. We also evaluated outcomes from the same era in a cohort of similar, non-PC4 hospitals. RESULTS During the baseline period, there was no evidence of improvement. We observed significant improvement in the post-exposure period versus baseline for post-operative intensive care unit mortality (2.1% vs. 2.7%; 22% relative reduction [RR]; p = 0.001), in-hospital mortality (2.5% vs. 3.3%; 24% RR; p = 0.001), major complications (10.1% vs. 11.5%; 12% RR; p < 0.001), intensive care unit length of stay (7.3 days vs. 7.7 days; 5% RR; p < 0.001), and duration of ventilation (61.3 h vs. 70.6 h; 13% RR; p = 0.01). Non-PC4 hospitals showed no significant improvement in mortality, complications, or hospital length of stay. CONCLUSIONS This analysis demonstrates improving cardiac surgical outcomes at children's hospitals participating in PC4. This change appears unrelated to secular improvement trends, and likely reflects PC4's commitment to transparency and collaboration. (C) 2019 by the American College of Cardiology Foundation.
引用
收藏
页码:2786 / 2795
页数:10
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