scholarly journals ASSOCIATION OF HOME MONITORING WITH INTERSTAGE MORTALITY, READMISSIONS, AND WEIGHT GAIN: A MULTICENTER STUDY FROM THE NATIONAL PEDIATRIC CARDIOLOGY QUALITY IMPROVEMENT COLLABORATIVE

2014 ◽  
Vol 63 (12) ◽  
pp. A498
Author(s):  
Matthew Oster ◽  
Alexandra Ehrlich ◽  
Eileen King ◽  
Christopher Petit ◽  
Martha Clabby ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Weight Gain ◽  
Multicenter Study ◽  
Pediatric Cardiology ◽  
Home Monitoring ◽  
Quality Improvement Collaborative ◽  
Interstage Mortality

Examining variation in interstage mortality rates across the National Pediatric Cardiology Quality Improvement Collaborative: do lower-mortality centres have lower-risk patients?

2018 ◽  
Vol 28 (8) ◽  
pp. 1031-1036 ◽  
Author(s):  
Katherine E. Bates ◽  
Sunkyung Yu ◽  
Ray Lowery ◽  
Sara K. Pasquali ◽  
David W. Brown ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Lower Risk ◽  
Pediatric Cardiology ◽  
Mortality Rates ◽  
Lower Mortality ◽  
Baseline Risk ◽  
Quality Improvement Collaborative ◽  
Risk Patients ◽  
Interstage Mortality

AbstractBackgroundAlthough interstage mortality for infants with hypoplastic left heart syndrome has declined within the National Pediatric Cardiology Quality Improvement Collaborative, variation across centres persists. It remains unclear whether centres with lower interstage mortality have lower-risk patients or whether differences in care may explain this variation. We examined previously established risk factors across National Pediatric Cardiology Quality Improvement Collaborative centres with lower and higher interstage mortality rates.MethodsLower-mortality centres were defined as those with >25 consecutive interstage survivors. Higher-mortality centres were defined as those with cumulative interstage mortality rates >10%, which is a collaborative historic baseline rate. Baseline risk factors and perioperative characteristics were compared.ResultsSeven lower-mortality centres were identified (n=331 patients) and had an interstage mortality rate of 2.7%, as compared with 13.3% in the four higher-mortality centres (n=173 patients, p<0.0001). Of all baseline risk factors examined, the only factor that differed between the lower- and higher-mortality centres was postnatal diagnosis (18.4 versus 31.8%, p=0.001). In multivariable analysis, there remained a significant mortality difference between the two groups of centres after adjusting for this variable: adjusted mortality rate was 2.8% in lower-mortality centres compared with 12.6% in higher-mortality centres, p=0.003. Secondary analyses identified multiple differences between groups in perioperative practices and other variables.ConclusionsVariation in interstage mortality rates between these two groups of centres does not appear to be explained by differences in baseline risk factors. Further study is necessary to evaluate variation in care practices to identify targets for improvement efforts.

Abstract 12605: Center Variability in Timing of Stage 2 Palliation and Association With Interstage Mortality: A Report From the National Pediatric Cardiology Quality Improvement Collaborative

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Garick Hill ◽  
Nancy Rudd ◽  
Nancy Ghanayem ◽  
David Hehir ◽  
Peter Bartz
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Pediatric Cardiology ◽  
Severity Of Illness ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Optimal Timing ◽  
Quality Improvement Collaborative ◽  
Interstage Mortality ◽  
The Impact

Introduction: The interstage period from discharge following stage 1 palliation (S1P) until stage 2 palliation (S2P) remains high risk. Significant variability between institutions exists around the timing of S2P. We sought to describe the variability in a multi-institution cohort and assess its association with interstage mortality. Methods: The National Pediatric Cardiology Quality Improvement Collaborative registry, with data from 52 centers, was queried. Patients undergoing a hybrid S1P, transplanted prior to S2P, lost to follow up prior to S2P or deemed not candidates for S2P were excluded. Only centers with 10 or greater patients meeting eligibility were included to reduce the impact of outliers. Centers were divided based on median age at S2P into early (n=15) and late (n=16) centers using a cutoff of 153 days. Groups were compared using Chi-squared or Wilcoxon rank sum test. Results: The final cohort included 789 patients from 31 centers. Center specific median age at S2P varied from 109 to 214 days, with a center mean of 158 ± 27 days. At S1P, the late centers had a higher prevalence of preoperative ventilation (34.7% vs. 26.9%, p=0.02) and longer average post-S1P duration of intubation (14.4 ± 19.7 vs. 10.2 ± 11.4 days, p<0.001) and S1P hospital length of stay (48.5 ± 30.4 vs. 38.5 ± 22.3 days, p<0.0001). Interstage mortality was significantly higher in centers performing late vs. early S2P (9.9% vs. 5.7%, p=0.03). Interstage event rate (late: 8.2 vs. early: 5.8 deaths per 10000 interstage days) was not different by group (p=0.26), but interstage duration was significantly longer (133.9 ± 71.5 vs. 103.4 ± 37.8 days, p<0.0001) in the late group. Survival to hospital discharge (98.9% in both groups, p>0.98) and hospital length of stay following S2P (late: 15.6 ± 22.3 vs. early: 13.7 ± 22.4, p=0.68) were similar between groups. Conclusions: In a large multi-institution collaborative, the median age at S2P varies between centers. Centers performing S2P at a later median age have higher interstage mortality. This may be in part due to a higher severity of illness, reflected by higher S1P morbidity in this group. Although optimal timing of S2P remains unclear, centers performing early S2P did not experience worse S2P outcomes, and experienced less interstage mortality.

scholarly journals IMPACT Registry and National Pediatric Cardiology Quality Improvement Collaborative: Contributions to Quality in Congenital Heart Disease

2019 ◽  
Vol 10 (1) ◽  
pp. 72-80 ◽  
Author(s):  
Gerard R. Martin ◽  
Jeffrey B. Anderson ◽  
Robert N. Vincent
Keyword(s):  
Congenital Heart Disease ◽  
Quality Improvement ◽  
Heart Disease ◽  
Congenital Heart ◽  
Pediatric Cardiology ◽  
Device Closure ◽  
Stent Angioplasty ◽  
Quality Improvement Collaborative ◽  
The Common ◽  
The Impact

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.

scholarly journals Identified mortality risk factors associated with presentation, initial hospitalisation, and interstage period for the Norwood operation in a multi-centre registry: a report from the National Pediatric Cardiology-Quality Improvement Collaborative

2013 ◽  
Vol 24 (2) ◽  
pp. 253-262 ◽  
Author(s):  
Russell R. Cross ◽  
Ashraf S. Harahsheh ◽  
Robert McCarter ◽  
Gerard R. Martin ◽  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Pediatric Cardiology ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Quality Improvement Collaborative ◽  
Interstage Mortality ◽  
Independent Risk Factors ◽  
Stage 1 ◽  
Left Heart Syndrome

AbstractIntroductionDespite improvements in care following Stage 1 palliation, interstage mortality remains substantial. The National Pediatric Cardiology-Quality Improvement Collaborative captures clinical process and outcome data on infants discharged into the interstage period after Stage 1. We sought to identify risk factors for interstage mortality using these data.Materials and methodsPatients who reached Stage 2 palliation or died in the interstage were included. The analysis was considered exploratory and hypothesis generating. Kaplan–Meier survival analysis was used to screen for univariate predictors, and Cox multiple regression modelling was used to identify potential independent risk factors.ResultsData on 247 patients who met the criteria between June, 2008 and June, 2011 were collected from 33 surgical centres. There were 23 interstage mortalities (9%). The identified independent risk factors of interstage mortality with associated relative risk were: hypoplastic left heart syndrome with aortic stenosis and mitral atresia (relative risk = 13), anti-seizure medications at discharge (relative risk = 12.5), earlier gestational age (relative risk = 11.1), nasogastric or nasojejunal feeding (relative risk = 5.5), unscheduled readmissions (relative risk = 5.3), hypoplastic left heart syndrome with aortic atresia and mitral stenosis (relative risk = 5.2), fewer clinic visits with primary cardiologist identified (relative risk = 3.1), and fewer post-operative vasoactive medications (relative risk = 2.2).ConclusionInterstage mortality remains substantial, and there are multiple potential risk factors. Future efforts should focus on further exploration of each risk factor, with potential integration of the factors into surveillance schemes and clinical practice strategies.

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