Quality improvement through collaboration: the National Pediatric Quality improvement Collaborative initiative

Area of Science:

• Pediatric Cardiology
• Quality Improvement Science
• Multicenter Collaboration

Background:

• Hypoplastic left heart syndrome (HLHS) and other single ventricle lesions pose significant challenges in pediatric care.
• The Norwood operation is a critical intervention for these complex congenital heart defects.
• Variations in care pathways can impact outcomes for affected children.

Purpose of the Study:

• To establish the National Pediatric Quality Improvement Collaborative (NPCQIC) for improving outcomes in HLHS.
• To decrease variations in care, develop best practices, and reduce mortality in pediatric single ventricle patients.
• To leverage quality improvement science and multicenter collaboration for enhanced patient care.

Main Methods:

• Formation of a collaborative network involving providers and families.
• Collection and analysis of longitudinal patient data.
• Application of quality improvement methodologies to identify and address practice variations.

Main Results:

• Identified significant variations in interstage care, surgical strategies, feeding practices, and ICU management across participating centers.
• Facilitated inter-center learning and implementation of process improvements.
• Achieved a 39.7% reduction in mortality, alongside improvements in other performance measures.

Conclusions:

• Multicenter collaboration, patient engagement, and quality improvement science are effective in improving care for rare pediatric conditions like HLHS.
• The NPCQIC model demonstrates the potential to drive significant positive change in clinical practice and patient outcomes.
• Shared learning within a collaborative network can overcome practice variations and lead to better results in complex pediatric cardiac surgery.