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Improvement in Pediatric Cardiac Surgical Outcomes Through Interhospital Collaboration.
Gaies, Michael; Pasquali, Sara K; Banerjee, Mousumi; Dimick, Justin B; Birkmeyer, John D; Zhang, Wenying; Alten, Jeffrey A; Chanani, Nikhil; Cooper, David S; Costello, John M; Gaynor, J William; Ghanayem, Nancy; Jacobs, Jeffrey P; Mayer, John E; Ohye, Richard G; Scheurer, Mark A; Schwartz, Steven M; Tabbutt, Sarah; Charpie, John R.
Afiliación
  • Gaies M; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: mgaies@med.umich.edu.
  • Pasquali SK; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
  • Banerjee M; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
  • Dimick JB; Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
  • Birkmeyer JD; Sound Physicians, Tacoma, Washington.
  • Zhang W; Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
  • Alten JA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • Chanani N; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
  • Cooper DS; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • Costello JM; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
  • Gaynor JW; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
  • Ghanayem N; Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
  • Jacobs JP; The Society of Thoracic Surgeons, Chicago, Illinois.
  • Mayer JE; Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts.
  • Ohye RG; Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
  • Scheurer MA; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
  • Schwartz SM; Departments of Pediatrics and Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Tabbutt S; Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California.
  • Charpie JR; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
J Am Coll Cardiol ; 74(22): 2786-2795, 2019 12 03.
Article en En | MEDLINE | ID: mdl-31779793
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Conducta Cooperativa / Cuidados Críticos / Mejoramiento de la Calidad / Cardiopatías Congénitas / Procedimientos Quirúrgicos Cardíacos / Unidades de Cuidados Intensivos Tipo de estudio: Clinical_trials Límite: Child, preschool / Female / Humans / Infant / Male / Newborn País/Región como asunto: America do norte Idioma: En Revista: J Am Coll Cardiol Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Conducta Cooperativa / Cuidados Críticos / Mejoramiento de la Calidad / Cardiopatías Congénitas / Procedimientos Quirúrgicos Cardíacos / Unidades de Cuidados Intensivos Tipo de estudio: Clinical_trials Límite: Child, preschool / Female / Humans / Infant / Male / Newborn País/Región como asunto: America do norte Idioma: En Revista: J Am Coll Cardiol Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos