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J Am Coll Cardiol. 2019 Dec 3;74(22):2786-2795. doi: 10.1016/j.jacc.2019.09.046.

Improvement in Pediatric Cardiac Surgical Outcomes Through Interhospital Collaboration.

Author information

1
Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: mgaies@med.umich.edu.
2
Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
3
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
4
Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
5
Sound Physicians, Tacoma, Washington.
6
Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
7
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
8
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
9
Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
10
Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
11
Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
12
The Society of Thoracic Surgeons, Chicago, Illinois.
13
Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.
14
Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
15
Departments of Pediatrics and Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
16
Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California.

Abstract

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.

KEYWORDS:

cardiac surgery; collaborative learning; congenital; outcomes; pediatric; quality

PMID:
31779793
DOI:
10.1016/j.jacc.2019.09.046

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