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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
World J Pediatr Congenit Heart Surg. Author manuscript; available in PMC 2013 November 14.
Published in final edited form as:
PMCID: PMC3827684
NIHMSID: NIHMS526123

Quality Measures for Congenital and Pediatric Cardiac Surgery

Abstract

This article presents 21 “Quality Measures for Congenital and Pediatric Cardiac Surgery” that were developed and approved by the Society of Thoracic Surgeons (STS) and endorsed by the Congenital Heart Surgeons’ Society (CHSS). These Quality Measures are organized according to Donabedian’s Triad of Structure, Process, and Outcome. It is hoped that these quality measures can aid in congenital and pediatric cardiac surgical quality assessment and quality improvement initiatives.

Keywords: database, outcomes, quality assessment, quality improvement

Background

Ongoing efforts directed at quality assessment and quality improvement in the field of pediatric and congenital cardiac disease1-3 coincide with maturation and expansion of registry databases.4-9 Analysis of these large repositories of data is fundamental to the assessment of outcomes from congenital and pediatric cardiac surgery at a multi-institutional level. It is apparent that substantial variability in the outcomes of pediatric and congenital cardiac surgery still exists.10 One aspect of overall quality improvement is the reduction in variability of outcomes across centers, and this improvement may be facilitated by adoption of measures and practices that are efficacious and widely applicable. The development and validation of “measures of quality” or “indicators of quality” is an essential step in this process and can facilitate the transformation of our outcome databases into platforms to assess and improve quality. These “quality measures” or “quality indicators” can then become a tool to facilitate multi-institutional quality improvement initiatives.

Quality Measures for Pediatric and Congenital Cardiac Surgery

The Society of Thoracic Surgeons (STS) designated a “Task Force to develop Quality Measures for Pediatric and Congenital Cardiac Surgery” in 2007 under the leadership of STS President John E. Mayer, MD. Members of this STS Task Force are listed in Table 1. This Task Force proposed a list of “Quality Measures for Congenital and Pediatric Cardiac Surgery.” The proposal was developed and approved unanimously by the STS Task Force to develop Quality Measures for Pediatric and Congenital Cardiac Surgery. The proposal was then reviewed and approved by the five STS Committees listed in Table 2, with final approval by the STS Executive Committee. The original set of “Quality Measures for Congenital and Pediatric Cardiac Surgery” that were proposed in 2007 have been updated and refined by members of the “Task Force to develop Quality Measures for Pediatric and Congenital Cardiac Surgery” to ensure consistency with the current version of the STS Congenital Heart Surgery Database.11

Table 1
Members of the STS Task Force to Develop Quality Measures for Pediatric and Congenital Cardiac Surgery
Table 2
Committees From Society of Thoracic Surgeons (STS) and Congenital Heart Surgeons’ Society (CHSS)

The Congenital Heart Surgeons’ Society (CHSS), in 2011, under the leadership of CHSS President Erle H. Austin III, MD, established a Committee on Quality Improvement and Outcomes, which has the following duties: (1) to create and facilitate multi-institutional initiatives to assess and improve the quality of care delivered to patients with congenital and pediatric heart disease, (2) to establish and maintain a CHSS-based resource for the evaluation of programmatic quality for programs caring for patients with congenital and pediatric congenital heart disease, and (3) to oversee the relationship and linkage of the CHSS to other databases in order to achieve the above objectives and simultaneously further the research mission of the CHSS.

In 2011, the CHSS endorsed the most recent version of the Quality Measures for Congenital and Pediatric Cardiac Surgery that were developed and approved by STS. These Quality Measures for Congenital and Pediatric Cardiac Surgery were unanimously endorsed by the two CHSS Committees listed in Table 2.

The Quality Measures for Congenital and Pediatric Cardiac Surgery that were developed and approved by STS and endorsed by CHSS are listed in Table 3 and described in detail in Table 4. Consensus definitions of the morbidities described in Tables 3 and and44 are provided in Table 5.5,11

Table 3
Quality Measures for Congenital and Pediatric Cardiac Surgery
Table 4
Quality Measures for Congenital and Pediatric Cardiac Surgery
Table 5
Consensus definitions of the morbidities

Discussion

At the present time, the evidence supporting the individual Quality Measures for Congenital and Pediatric Cardiac Surgery that are presented in Tables 3 and and44 ranges from consensus of the opinion of experts to published data from analysis of large multi-institutional data sets.12 Additional data to support these proposed quality measures will be gathered by the STS Congenital Heart Surgery Database. A Quality Module of the STS Congenital Heart Surgery Database is currently under development in order to achieve this objective.

These Quality Measures are harmonized with several ongoing congenital and pediatric cardiac surgical quality and outcomes initiatives.

  1. The Quality Measures for Congenital and Pediatric Cardiac Surgery are harmonized with all nomenclature, standards, and rules currently used by the STS and the European Association for Cardio-Thoracic Surgery (EACTS) in the STS Congenital Heart Surgery Database and the EACTS Congenital Heart Surgery Database.11,13,14
  2. Both STS and EACTS developed and published the STS-EACTS Congenital Heart Surgery Mortality Score and STS-EACTS Congenital Heart Surgery Mortality Categories.12 A similar initiative to develop a Congenital Heart Surgery Morbidity Score and Congenital Heart Surgery Morbidity Categories is nearing completion. The measures of morbidity in these Quality Measures for Congenital and Pediatric Cardiac Surgery are harmonized with the measures of morbidity in the proposed Congenital Heart Surgery Morbidity Score and Congenital Heart Surgery Morbidity Categories.
  3. The Quality Measures for Congenital and Pediatric Cardiac Surgery are harmonized with recent analyses performed with the STS Congenital Heart Surgery Database that examine “Variation in Outcomes for Benchmark Operations”.10
  4. The Quality Measures for Congenital and Pediatric Cardiac Surgery are harmonized with ongoing analyses performed with the STS Congenital Heart Surgery Database that examine “Failure to Rescue,” which is the concept of measuring survival versus nonsurvival following complications as a potential measure of performance.15-17

Efforts are already underway to gather data to assess these quality measures in the following domains: reliability, validity, importance, scientific acceptability, usability, and feasibility. Questions to be answered include a determination of the relationship of structure measures and process measures to outcome, the assessment as to whether this relationship is one of “cause and effect” or simply “association,” and an analysis of possible unintended consequences of any of these measures.

Eventually, efforts to measure and improve the quality of care of patients with congenital and/or pediatric cardiac disease must also span temporal, geographical, and subspecialty boundaries.2,9 As such, development of additional measures of quality should include longitudinal follow-up with longitudinal assessment of quality, global collaboration, and multidisciplinary involvement.

Conclusions

This article presents 21 Quality Measures for Congenital and Pediatric Cardiac Surgery that were developed and approved by STS and endorsed by CHSS. These quality measures are organized according to Donabedian’s Triad of Structure, Process, and Outcome. It is hoped that these quality measures can aid in congenital and pediatric cardiac surgical quality assessment and quality improvement initiatives.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

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