VARIATION IN PRE- AND INTRA-OPERATIVE CARE FOR FIRST STAGE PALLIATION FOR SINGLE VENTRICLE HEART DISEASE: REPORT FROM THE NATIONAL QUALITY IMPROVEMENT COLLABORATIVE

The IMproving Pediatric and Adult Congenital Treatments (IMPACT) Registry and the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) are two efforts initiated to improve outcomes in the congenital heart disease field. The IMPACT Registry is focused on evaluating the use, risks, adverse events (AEs), and outcomes associated with diagnostic and common interventional catheterization procedures in all children and adults with congenital heart disease. Utilizing a modular approach, the common procedures include diagnostic cardiac catheterization, atrial septal defect device closure, patent ductus arteriosus device closure, pulmonary valvuloplasty, aortic valvuloplasty, balloon and stent angioplasty of coarctation of the aorta, pulmonary artery balloon stent angioplasty, transcatheter pulmonary valve replacement, and electrophysiology procedures including radiofrequency ablation. To date, important observations on the common procedures have been made and a risk stratification methodology has been created to allow comparisons between centers in AEs and quality improvement activity. The registry is open to international participation. The NPC-QIC was developed to reduce mortality and improve the quality of life of infants with Hypoplastic Left Heart Syndrome (HLHS) during the interstage period between discharge from the Norwood operation and admission for the bidirectional Glenn procedure. Mortality in the interstage has been reduced by 44%. The IMPACT Registry and the NPC-QIC have demonstrated value to the congenital heart disease community. The IMPACT Registry, however, has not yet demonstrated an impact on patient outcomes. The NPC-QIC, which combines both a registry with a learning collaborative with specific aims, key drivers, and change strategies, has made more significant gains with reductions in variation, growth failures, and mortality.

Download Full-text

Decreasing Readmissions through Opportunities Provided (DROP): The First National Quality Improvement Collaborative from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2016.08.030 ◽

2016 ◽

Vol 12 (7) ◽

pp. S1-S2 ◽

Cited By ~ 9

Author(s):

John Morton ◽

Stacy Brethauer ◽

Teresa Fraker ◽

Jennifer Bradford ◽

Kristopher Huffman ◽

...

Keyword(s):

Bariatric Surgery ◽

Quality Improvement ◽

Quality Improvement Program ◽

Quality Improvement Collaborative ◽

Improvement Program ◽

National Quality ◽

Metabolic And Bariatric Surgery

Download Full-text

An evaluation of a multifaceted, local Quality Improvement Framework for long-term conditions in UK primary care

Family Practice ◽

10.1093/fampra/cmy128 ◽

2018 ◽

Vol 36 (5) ◽

pp. 607-613 ◽

Cited By ~ 1

Author(s):

Frank Gabel ◽

Ruth Chambers ◽

Tracey Cox ◽

Stefan Listl ◽

Neal Maskrey

Keyword(s):

Coronary Heart Disease ◽

Quality Improvement ◽

Heart Disease ◽

Fixed Effects ◽

Pay For Performance ◽

Unintended Consequences ◽

Mortality Data ◽

Periodic Review ◽

Long Term Conditions ◽

National Quality

Abstract Background The evidence that large pay-for-performance schemes improve the health of populations is mixed—evidence regarding locally implemented schemes is limited. Objective This study evaluates the effects in Stoke-on-Trent of a local, multifaceted Quality Improvement Framework including pay for performance in general practice introduced in 2009 in the context of the national Quality and Outcomes Framework that operated from 2004. Methods We compared age-standardized mortality data from all 326 local authorities in England with the rates in Stoke-on-Trent using Difference-in-Differences, estimating a fixed-effects linear regression model with an interaction effect. Results In addition to the existing downward trend in cardiovascular deaths, we find an additional annual reduction of 36 deaths compared with the national mean for coronary heart disease and 13 deaths per 100000 from stroke in Stoke-on-Trent. Compared with the national mean, there was an additional reduction of 9 deaths per 100000 people per annum for coronary heart disease and 14 deaths per 100000 people per annum for stroke following the introduction of the 2009 Stoke-on-Trent Quality Improvement Framework. Conclusion There are concerns about the unintended consequences of large pay-for-performance schemes in health care, but in a population with a high prevalence of disease, they may at least initially be beneficial. This study also provides evidence that a local, additional scheme may further improve the health of populations. Such schemes, whether national or local, require periodic review to evaluate the balance of their benefits and risks.

Download Full-text