Improvement in Interstage Survival in a National Pediatric Cardiology Learning Network
| Autor: | John D. Kugler, David W. Brown, Carole Lannon, Steven R. Neish, Jeffrey B. Anderson, Lloyd P. Provost, Eileen King, Robert H. Beekman, Gerard R. Martin, Geoffrey L. Rosenthal, Kathy J. Jenkins, Laura E. Peterson, Colleen Mangeot, Thomas S. Klitzner |
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| Rok vydání: | 2015 |
| Předmět: |
Heart Defects
Congenital medicine.medical_specialty Quality management Heart disease medicine.medical_treatment Population Cardiology Disease Hypoplastic left heart syndrome medicine Humans Learning Child Intensive care medicine education education.field_of_study business.industry Disease Management medicine.disease Quality Improvement United States Norwood Operation Survival Rate Norwood procedure Outcomes research Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation: Cardiovascular Quality and Outcomes. 8:428-436 |
| ISSN: | 1941-7705 1941-7713 |
| Popis: | Infants with univentricular congenital heart disease (CHD), including those with hypoplastic left heart syndrome (HLHS), regularly pose dilemmas in decision-making because their anatomy and physiology are often unique and variable. The typical staged surgical course for infants with complex univentricular anatomy with systemic outflow obstruction begins with the Norwood (stage 1) operation or variant shortly after birth, followed several months later by superior cavopulmonary anastomosis (stage 2 palliation) with an ultimate goal of a Fontan-type operation several years later.1–3 Improvement in surgical and postoperative management has led to considerable improvement in early post-Norwood survival in the recent era.4–7 However, after the Norwood procedure and before stage 2 palliation, a high-risk time period termed interstage, mortality has been previously been reported at 10% to 15%.8–10 The rare nature of this disorder has limited robust learning about successful strategies to improve survival undertaken by single-surgical centers, and a gap exists in our ability to further improve mortality in this population. The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC), the first multicenter learning network within pediatric cardiology,11 was established with the goal of improving care and outcomes for children with univentricular heart after the Norwood operation and specifically to (1) improve interstage mortality, (2) decrease interstage growth failure, and (3) reduce interstage hospital readmissions for major medical events. There were several perceived challenges to success in changing clinical outcomes before starting the NPC-QIC collaborative. A primary challenge in collaboration among multiple sites can be agreement on best practices that should be implemented. This is especially true for rare diseases, such as univentricular heart disease, where evidence-based clinical guidelines are not available to clinicians. As noted above, major variation persists in management practices among individuals and institutions caring for children with HLHS and other … |
| Databáze: | OpenAIRE |
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