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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Development of a Congenital Heart Surgery Composite Quality Metric: Part 1-Conceptual Framework
Sara K Pasquali1, David M Shahian2, Sean M O'Brien3
1Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan.
Insights
A new composite quality metric for pediatric heart surgery includes mortality and morbidity, offering a more comprehensive view than just survival rates. This metric aims to improve hospital performance evaluation in congenital heart surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Quality Measurement
- Healthcare Outcomes
Background:
- Current pediatric and congenital heart surgery quality measures primarily focus on operative mortality.
- Stakeholders seek more comprehensive quality assessment methods.
- This report details the development of the first composite quality metric in the field.
Purpose of the Study:
- To develop and describe the first composite quality metric for congenital heart surgery.
- To expand the assessment of quality beyond operative mortality.
- To provide a framework for a more comprehensive evaluation of care.
Main Methods:
- A multidisciplinary panel reviewed existing quality measurement frameworks and composite measures from adult cardiac surgery and other fields.
- Methodology and measures for a congenital heart surgery composite were developed, considering Donabedian's triad and Institute of Medicine quality domains.
- Decisions were reached through group consensus.
Main Results:
- The developed composite measure includes a mortality domain (operative mortality) and a morbidity domain.
- The morbidity domain incorporates 6 major complications, cardiac arrest, and postoperative length of stay.
- Potential advantages include a broader quality view and improved hospital performance discrimination; limitations include lack of long-term outcomes and case-mix adjustment challenges.
Conclusions:
- Conceptual frameworks and methodologies for composite quality measures were successfully applied and adapted to congenital heart surgery.
- The newly created composite quality metric integrates both morbidity and mortality.
- This metric broadens the perspective on quality of care for pediatric heart surgery patients.
Background:
Current pediatric and congenital heart surgery quality measures focus on operative mortality, and numerous stakeholders are interested in more comprehensive measures. This report describes the background, rationale, and conceptual framework related to the development of the first composite quality metric in the field.
Methods:
A multidisciplinary panel reviewed methodology and framework related to quality measurement and several composite quality measures across adult cardiac surgery and other fields. The panel subsequently developed methodology and selected measures for a congenital heart surgery composite measure and reviewed potential advantages and limitations. Individual measures considered for potential inclusion in the composite were reviewed within the context of Donabedian's triad and the Institute of Medicine quality domains. Decisions were made through group consensus.
Results:
The final composite measure selected is comprised of two domains: (1) a mortality domain (operative mortality) and (2) a morbidity domain (the 6 major complications endorsed by The Society of Thoracic Surgeons and Congenital Heart Surgeons Society plus cardiac arrest, and postoperative length of stay). Potential advantages include the more comprehensive view of quality compared with mortality alone and improvements in discrimination of hospital performance through increasing the number of end points. Potential limitations include the lack of longer term outcomes and challenges related to case-mix adjustment.
Conclusions:
We have applied and adapted conceptual framework and methodology related to composite quality measures across other fields to congenital heart surgery. The composite quality metric created is inclusive of both morbidity and mortality, and expands our view of quality in this patient population.
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