Abstract
ObjectiveASSIST 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.MethodsA 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.ResultsMany 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).ConclusionThe 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.
Highlights
Treatment of congenital heart disease has evolved in the last decades, with many technical and technological advances
The ASSIST project was successfully created over a solid base of collaborative work
There is a great number of examples of successful programs, such as the Pediatric Cardiac Critical Care Consortium (PC4), which includes some of the best USA pediatric cardiac centers, and the International Quality Improvement Collaborative (IQIC), designed as a consortium focused on developing countries doing pediatric cardiac surgery
Summary
Treatment of congenital heart disease has evolved in the last decades, with many technical and technological advances. There is a great number of examples of successful programs, such as the Pediatric Cardiac Critical Care Consortium (PC4), which includes some of the best USA pediatric cardiac centers, and the International Quality Improvement Collaborative (IQIC), designed as a consortium focused on developing countries doing pediatric cardiac surgery They have in common a strong database, a powerful data analysis center, and a structure based on the Learning Health System model described by the Institute of Medicine, in which patients, clinicians, researchers, and other stakeholders collaborate in a meaningful partnership to improve outcomes and generate new knowledge, and where healthcare improvement and research are purposefully integrated[4,5]
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