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Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in
Seungheon Han1,2, Sugy Choi3,2, Jongho Heo4,2
1Institute of International Affairs, Seoul National University, Seoul, KR.
Insights
A decade-long pediatric cardiac surgery training program in Uzbekistan significantly improved surgical capacity and patient outcomes. This collaborative approach enhanced medical staff skills and positively impacted families, offering a model for other low- and middle-income countries.
Area of Science:
- Global Health
- Pediatric Surgery
- Medical Education
Background:
- Congenital heart disease care is limited in low- and middle-income countries (LMICs).
- A 10-year collaborative training program in Tashkent, Uzbekistan, aimed to enhance local pediatric cardiac surgical capacity.
- The program involved knowledge and skills transfer through joint surgeries and care from 2009-2019.
Purpose of the Study:
- To assess the long-term impact of the collaborative program on surgical capacity.
- To evaluate changes in surgical complexity (RACHS-1 score) and patient pre-surgical weights.
- To understand the program's effects on medical staff teamwork, skills, attitudes, and patient/family well-being.
Main Methods:
- Mixed-methods design over a decade (2009-2019).
- Analysis of 107 surgical cases, including Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) scores and patient weights.
- Qualitative data from 31 in-depth interviews with Uzbek and Korean medical staff and caregivers.
Main Results:
- Average RACHS-1 score increased from 1.9 to 2.78, indicating more complex surgeries.
- Average patient pre-surgical weight decreased by 2.8 kg.
- Improved surgical capacity, teamwork, and attitudes among Uzbek medical staff, with positive patient/family outcomes.
Conclusions:
- Sustained, team-based training effectively improved pediatric cardiac surgical capacity in Uzbekistan.
- The program demonstrated positive impacts on medical staff and patient/family lives.
- This model offers a viable solution for improving pediatric cardiovascular care in LMICs.
Background:
Most children who have congenital heart disease in low- and middle-income countries (LMICs), including Uzbekistan, do not receive adequate and timely pediatric cardiac surgical care. To strengthen the surgical capacity of a local pediatric cardiac surgery team in Tashkent, Uzbekistan, the JW LEE Center for Global Medicine at Seoul National University College of Medicine has developed a team-based training program and has been collaboratively conducting surgeries and care in order to transfer on-site knowledge and skills from 2009 to 2019.
Objectives:
To evaluate the long-term effects of the collaborative program on the cardiac surgical capacity of medical staff (teamwork, surgical complexity, and patients' pre-surgical weights) as well as changes in the lives of the patients and their families. To derive lessons and challenges for other pediatric cardiac surgical programs in LMICs.
Methods:
To assess the effects of this ten-year long program, a mixed-methods design was developed to examine the trend of surgical complexity measured by Risk Adjustment for Congenital Heart Surgery 1 score (RACHS-1) and patients' pre-surgical weights via medical record review (surgical cases: n = 107) during the decade. Qualitative data was analyzed from in-depth interviews (n = 31) with Uzbek and Korean medical staff (n = 10; n = 4) and caregivers (n = 17).
Findings:
During the decade, the average RACHS-1 of the cases increased from 1.9 in 2010 to 2.78 in 2019. The average weight of patients decreased by 2.8 kg from 13 kg to 10.2 kg during the decade. Qualitative findings show that the surgical capacity, as well as attitudes toward patients and colleagues of the Uzbek medical staff, improved through the effective collaboration between the Uzbek and Korean teams. Changes in the lives of patients and their families were also found following successful surgery.
Conclusions:
Team-based training of the workforce in Uzbekistan was effective in improving the surgical skills, teamwork, and attitudes of medical staff, in addition, a positive impact on the life of patients and their families was demonstrated. It can be an effective solution to facilitate improvements in pediatric cardiovascular disease in LMICs if training is sustained over a long period.
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