Collaborative quality improvement in the congenital heart defects: development of the assist consortium and a preliminary surgical outcomes report
Rev. bras. cir. cardiovasc
;
32(4): 260-269, July-Aug. 2017. tab, graf
Artículo
en Inglés
| LILACS
| ID: biblio-897919
ABSTRACT
Abstract Objective:
ASSIST is the first Brazilian initiative in building a collaborative quality improvement program in pediatric cardiology and congenital heart disease. The purposes of this manuscript are (a) to describe the development of the ASSIST project, including the historical, philosophical, organizational, and infrastructural components that will facilitate collaborative quality improvement in congenital heart disease care; (b) to report past and ongoing challenges faced; and (c) to report the first preliminary data analysis.Methods:
A total of 614 operations were prospectively included in a comprehensive online database between September 2014 and December 2015 in two participating centers. Risk Adjustment for Congenital Heart Surgery (RACHS) 1 and Aristotle Basic Complexity (ABC) scores were obtained. Descriptive statistics were provided, and the predictive values of the two scores for mortality were calculated by multivariate logistic regression models.Results:
Many barriers and challenges were faced and overcome. Overall mortality was 13.4%. Independent predictors of in-hospital death were RACHS-1 categories (3, 4, and 5/6), ABC level 4, and age group (≤ 30 days, and 30 days - 1 year).Conclusion:
The ASSIST project was successfully created over a solid base of collaborative work. The main challenges faced, and overcome, were lack of institutional support, funding, computational infrastructure, dedicated staff, and trust. RACHS-1 and ABC scores performed well in our case mix. Our preliminary outcome analysis shows opportunities for improvement.
Texto completo:
Disponible
Índice:
LILACS (Américas)
Asunto principal:
Evaluación de Procesos y Resultados en Atención de Salud
/
Mejoramiento de la Calidad
/
Cardiopatías Congénitas
Tipo de estudio:
Ensayo Clínico Controlado
/
Estudio de etiología
/
Estudios de evaluación
/
Estudio observacional
/
Estudio pronóstico
/
Factores de riesgo
Límite:
Adolescente
/
Niño
/
Child, preschool
/
Femenino
/
Humanos
/
Lactante
/
Masculino
/
Recién Nacido
País/Región como asunto:
America del Sur
/
Brasil
Idioma:
Inglés
Revista:
Rev. bras. cir. cardiovasc
Asunto de la revista:
Cardiología
/
Cirugía General
Año:
2017
Tipo del documento:
Artículo
País de afiliación:
Brasil
Institución/País de afiliación:
Universidade de São Paulo/BR
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