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
Article
in English
| LILACS
| ID: biblio-897919
Responsible library:
BR1.1
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.
Full text:
Available
Collection:
International databases
Database:
LILACS
Main subject:
Outcome and Process Assessment, Health Care
/
Quality Improvement
/
Heart Defects, Congenital
Type of study:
Controlled clinical trial
/
Etiology study
/
Evaluation study
/
Observational study
/
Prognostic study
/
Risk factors
Aspects:
Implementation research
Limits:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
/
Infant, Newborn
Country/Region as subject:
South America
/
Brazil
Language:
English
Journal:
Rev. bras. cir. cardiovasc
Journal subject:
Cardiology
/
CIRURGIA GERAL
Year:
2017
Document type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Universidade de São Paulo/BR