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Finding better ways to compare pediatric heart care quality

comparing pediatric heart care qualityThe fields of pediatric cardiology and cardiac surgery have come a long way. Today, conditions that were universally fatal as recent as 30 years ago can now be successfully treated, allowing children with congenital heart disease to thrive into adulthood.

However, we also know that there is much more work to be done to ensure that all children with heart disease have access to the highest quality care. One thing that is important is to be able to identify and learn from those hospitals with the best outcomes who are providing the highest pediatric heart care quality to children with heart disease.

It’s not easy to do, though. This is because outcomes can be influenced by the type of patients a hospital cares for. Some hospitals may on average care for very complex patients, while others for example may refer these patients elsewhere. In order to really understand who is providing the highest quality care, it is important to understand these factors so that hospitals taking care of the sickest patients are not unfairly penalized when comparing data across hospitals.

Most of the methods developed for evaluating outcomes and quality across hospitals have focused on accounting for differences in the types of heart defects that a hospital treats in relation to other hospitals. My colleagues and I suspected, however, there may be other important factors to consider. We know that the outcome of a patient is influenced not only by the type of congenital heart disease, but also by other factors that may not be related to the heart, but still important. These include things like being born prematurely, how much an infant weighs at the time of surgery, or the presence of a genetic syndrome or other types of birth defects not related to the heart.

To study the importance of factoring in these other “patient characteristics,” our research team did an analysis of more than 50,000 children undergoing heart surgery across 86 hospitals. We used data from the Society of Thoracic Surgeons Congenital Heart Surgery Database for the study. We found that these patient characteristics varied widely across the hospitals. For example, some hospitals cared for more than two times the number of infants with a low birth weight than others. This is important because surgery in these infants (particularly those weighing less than 5 pounds at the time of surgery) can be more risky. Other types of patient characteristics also varied widely across these 86 hospitals, including the number of patients undergoing heart surgery who were born prematurely, and the number of patients having another type of birth defect not related to the heart, among many other factors.

Why is this important?
We found that “leveling the playing field,” or giving centers credit for taking care of these higher patients is important. For example, if these important patient characteristics are not taken into account, it could give the false impression that a center is not providing high quality care, when in reality they are a top performer and a hospital we should be learning from.

By taking into account both the type of heart disease a hospital treats and the characteristics of the patients that they treat, we get a more accurate picture of the outcomes and quality of care delivered by each program in relation to other hospitals. This is information is important for a variety of reasons:

  • Knowing which hospitals truly have the best outcomes allows other programs to benchmark their care against the high performing hospitals, with a goal of learning from these hospitals and improving outcomes.
  • Accurate measurements are meaningful to patients and parents in making the decision regarding where to seek care for their child with congenital heart disease.
  • The federal government will increasingly be paying hospitals based on the quality of care they provide.

My colleagues and I were honored that this important research was chosen to receive the Richard E. Clark award at the Society of Thoracic Surgeons 51st Annual Meeting this past January.

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Sara Pasquali, MD, Pediatric CardiologySara K. Pasquali, MD, MHS is an Associate Professor in the Division of Pediatric Cardiology at C.S. Mott Children’s Hospital at the University of Michigan, and is also a faculty member at the Center for Healthcare Outcomes & Policy. Dr. Pasquali’s research, funded by the National Heart, Lung, and Blood Institute, focuses on evaluation of outcomes and quality in children undergoing heart surgery. She Co-Directs the Michigan Congenital Heart Outcomes Research and Discovery (M-CHORD) Program at C.S. Mott Children’s Hospital.

best children's hospitalsUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.