Linking world bank development indicators and outcomes of congenital heart surgery in low-income and middle-income countries: retrospective analysis of quality improvement data

Autor: Raman Krishna Kumar, Kaitlin Doherty, Kathy J. Jenkins, Nestor Sandoval, Sarah Rahman, David de Ferranti, Jan T. Christenson, Bistra Zheleva, William M. Novick, K.M. Cherian, Patricia A. Hickey, Jennifer Koch Kupiec, Kimberlee Gauvreau
Rok vydání: 2019
Předmět:
Male
Standardized mortality ratio
Heart disease
Hospital mortality
Life expectancy
International Cooperation
Gross national product
030204 cardiovascular system & hematology
Global Health
Health care cost
surgery
0302 clinical medicine
Health care
Per capita
Middle income country
Hospital Mortality
Registries
030212 general & internal medicine
Child
Hospital discharge
Risk assessment
Paediatric cardiology
Total quality management
General Medicine
Register
Investment (macroeconomics)
congenital heart disease
Quality Improvement
Surgical mortality
Retrospective study
Child
Preschool
Medicine
Female
Prematurity
Surgical risk
Human
Heart Defects
Congenital
Adult
medicine.medical_specialty
Adolescent
Investment strategy
Gross Domestic Product
Data analysis
Context (language use)
Major clinical study
Audit
Risk Assessment
Article
paediatrics
03 medical and health sciences
medicine
Humans
Developing Countries
Retrospective Studies
Congenital heart disease
Lowest income group
paediatric cardiology
business.industry
Research
Malnutrition
Infant
Newborn
Infant
Paediatrics
World bank
Hospital admission
medicine.disease
Mortality rate
Heart surgery
Surgery
Outcome assessment
Health service
School child
Investment
business
Zdroj: BMJ Open, Vol 9, Iss 6 (2019)
Repositorio EdocUR-U. Rosario
Universidad del Rosario
instacron:Universidad del Rosario
BMJ Open
ISSN: 2044-6055
DOI: 10.1136/bmjopen-2018-028307
Popis: ObjectiveMany low-income and middle-income countries (LMICs) struggle to provide the health services investment required for life-saving congenital heart disease (CHD) surgery. We explored associations between risk-adjusted CHD surgical mortality from 17 LMICs and global development indices to identify patterns that might inform investment strategies.DesignRetrospective analysis: country-specific standardised mortality ratios were graphed against global development indices reflective of wealth and healthcare investment. Spearman correlation coefficients were calculated.Setting and participantsThe International Quality Improvement Collaborative (IQIC) keeps a volunteer registry of outcomes of CHD surgery programmes in low-resource settings. Inclusion in the IQIC is voluntary enrolment by hospital sites. Patients in the registry underwent congenital heart surgery. Sites that actively participated in IQIC in 2013, 2014 or 2015 and passed a 10% data audit were asked for permission to share data for this study. 31 sites in 17 countries are included.Outcome measuresIn-hospital mortality: standardised mortality ratios were calculated. Risk adjustment for in-hospital mortality uses the Risk Adjustment for Congenital Heart Surgery method, a model including surgical risk category, age group, prematurity, presence of a major non-cardiac structural anomaly and multiple congenital heart procedures during admission.ResultsThe IQIC registry includes 24 917 congenital heart surgeries performed in childrenConclusionsResults display a moderate relationship among wealth, healthcare investment and malnutrition, with significant variation, including superior results in many countries with low GDP per capita. These findings provide context and optimism for investment in CHD procedures in low-resource settings.
Databáze: OpenAIRE
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