International Quality Improvement Collaborative for Congenital Heart Surgery in the Developing World

  • Ms Melyssa Sueiro, Children's Hospital Boston, United States
  • Dr Jan Christenson, University Hospital of Geneva, Switzerland
  • Dr William Novick, University of Tennessee, United States
  • Dr Aldo Castaneda, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala
  • Dr Jean Connor, United States
  • Dr Kimberlee Gauvreau, Children's Hospital Boston, United States
  • Ravi Agarwal, Frontier Lifeline Hospital, India
  • Frank Molloy, Internacional Children’s Herat Foundation, United States
  • Juan Velez, Clinica Medellin, Colombia
  • Iftikhar Ahmed, Armed Forces Institute of Cardiology/National Institute for Heart Diseases, Pakistan
  • Sunil Gunness, Cardiac Centre, Mauritius
  • Zhaohui Lu, Shanghai Children's Medical Center, China
  • Ivan Vides, Cardiovascular Unit (UNICAR) Hospital in Guatemala, Guatemala
  • Dr Vitaly Dedovich, Childrens Cardiac Centre, Hospital No 1, Belarus
  • Dr Kathy Jenkins, Children's Hospital Boston, United States

    • Background: Partnerships between established and developing programs have accelerated availability of congenital heart surgery globally. The need for benchmarking data and the opportunity for collaborative quality improvement was identified at the Global Forum for Humanitarian Medicine in Cardiology and Cardiac Surgery, Geneva 2007. Seven international sites participated in the pilot phase. Representatives traveled to Boston in June 2008 to attend the first International Quality Improvement Collaborative for Congenital Heart Surgery meeting. Consensus was established on clinical, procedural and outcome data to be collected.

    Methods: Sites submit data using a web-based data tool to a central data repository. Diagnostic and procedural information are entered using International Pediatric Congenital Cardiac Codes, including occurrence of in-hospital or 30-day death, and surgical site or blood stream infection. Institutions will receive biannual reports with individual and comparative data, including risk-adjusted mortality rates using the RACHS-1 method.

    Results: Data collected (n=410 cases thus far) from September 2008 to March 2009 will be included in the first report. Initial findings will be evaluated at the next meeting in Geneva, June 2009. Sites will also work together to develop and implement improvement strategies, based on the initial results, and new institutions will be invited to participate.

    Conclusion: A collaborative approach to quality improvement devoted to developing programs should accelerate the spread of best practices to children with congenital heart disease globally.