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One Size Does Not Fit All: Comparing CDH Team Structure Across Children's Hospitals in the United States of America
Sharada Hiranya Gowda1, Thomas Nienaber2,3, Abhishek Makkar4
1Texas Children's Hospital, Baylor College of Medicine, Department of Pediatrics, Texas, United States, Houston.
Insights
Congenital diaphragmatic hernia (CDH) care varies significantly across hospitals. Optimizing outcomes requires a multidisciplinary team approach with clear ownership and seamless transitions for complex congenital anomaly management.
Area of Science:
- Pediatric Surgery
- Neonatology
- Maternal-Fetal Medicine
Background:
- Congenital diaphragmatic hernia (CDH) presents significant morbidity and mortality.
- Center-specific factors and team structure critically influence CDH outcomes.
- Interprofessional collaboration is vital for successful CDH management.
Purpose of the Study:
- To describe the heterogeneity in CDH care models across US children's hospitals.
- To identify key elements of effective CDH management teams.
Main Methods:
- Qualitative study of 12 children's hospitals in the USA.
- Survey data focused on multidisciplinary approaches and care patterns from fetal diagnosis to long-term follow-up.
- Evaluation of team structures and clinical practices for CDH.
Main Results:
- Significant variation exists in CDH care models, from neonatology-led services to dedicated CDH units.
- Care models range from primary neonatology service to dedicated CDH units.
- Team structures vary widely, impacting prenatal consults to extracorporeal life support (ECLS) initiation.
Conclusions:
- Heterogeneity in CDH care models is evident, with a common need for expert, dedicated clinical teams.
- Multidisciplinary collaboration and seamless care transitions are crucial for optimizing CDH patient outcomes.
- A tailored, standardized model integrating best practices and local resources can improve consistent, high-quality CDH care.
Background:
Congenital diaphragmatic hernia (CDH) is a complex anomaly with high rates of morbidity and mortality. Successful management depends on interprofessional and multidisciplinary collaboration. Multiple previous publications have underscored the effect that center-specific factors can have on CDH outcomes. However, beyond institutional differences, optimal outcomes also rely on a well-composed team with both surgical and critical care expertise. Understanding the center effect requires identifying key drivers, with team structure being a major factor. While surgeons and neonatologists often lead, maternal-fetal medicine (MFM) specialists and other interdisciplinary members play essential roles. Team composition and ownership vary across centers, shaped by geography, program origins, historical practices, and evolving institutional norms.
Objective:
Describe the variation in CDH-specific care models among sample children's hospitals across the USA.
Study Design:
This was a qualitative study evaluating care models among 12 children's hospitals in the USA. Data were obtained by surveying each center with an emphasis on multidisciplinary approach, current practice patterns from fetal diagnosis to discharge and long-term follow-up specific to CDH.
Results:
We describe a representative sample of 12 children's hospitals whose CDH programs range from primary neonatology service to a dedicated CDH unit and multiple variations of team structure starting from prenatal consults to initiation of extracorporeal life support (ECLS).
Conclusion:
We found that there is significant heterogeneity in this sample cohort in CDH care models with a common underlying theme of a core team of clinicians with expertise and majority of their dedicated service time allotted to this specific congenital anomaly. Our analysis highlights key elements such as multidisciplinary collaboration and seamless care transition that are essential for optimizing outcomes. A tailored, standardized model incorporating best practices across institutions with available local resources may offer the most practical path toward consistent, high-quality care.
Key Points:
· Team structure determines improved participation and ownership.. · CDH needs team-based management.. · Multidisciplinary multipronged expertise with united vision makes for better team..