Sara K Pasquali1, David M Shahian2, Sean M O'Brien3, Marshall L Jacobs4, J William Gaynor5, Jennifer C Romano6, Michael G Gaies7, Kevin D Hill3, John E Mayer8, Jeffrey P Jacobs4. 1. Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan. Electronic address: pasquali@med.umich.edu. 2. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. 4. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida. 5. Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 6. Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan. 7. Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan. 8. Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Current pediatric and congenital heart surgery quality measures focus on operative mortality, and numerous stakeholders are interested in more comprehensive measures. This report describes the background, rationale, and conceptual framework related to the development of the first composite quality metric in the field. METHODS: A multidisciplinary panel reviewed methodology and framework related to quality measurement and several composite quality measures across adult cardiac surgery and other fields. The panel subsequently developed methodology and selected measures for a congenital heart surgery composite measure and reviewed potential advantages and limitations. Individual measures considered for potential inclusion in the composite were reviewed within the context of Donabedian's triad and the Institute of Medicine quality domains. Decisions were made through group consensus. RESULTS: The final composite measure selected is comprised of two domains: (1) a mortality domain (operative mortality) and (2) a morbidity domain (the 6 major complications endorsed by The Society of Thoracic Surgeons and Congenital Heart Surgeons Society plus cardiac arrest, and postoperative length of stay). Potential advantages include the more comprehensive view of quality compared with mortality alone and improvements in discrimination of hospital performance through increasing the number of end points. Potential limitations include the lack of longer term outcomes and challenges related to case-mix adjustment. CONCLUSIONS: We have applied and adapted conceptual framework and methodology related to composite quality measures across other fields to congenital heart surgery. The composite quality metric created is inclusive of both morbidity and mortality, and expands our view of quality in this patient population.
BACKGROUND: Current pediatric and congenital heart surgery quality measures focus on operative mortality, and numerous stakeholders are interested in more comprehensive measures. This report describes the background, rationale, and conceptual framework related to the development of the first composite quality metric in the field. METHODS: A multidisciplinary panel reviewed methodology and framework related to quality measurement and several composite quality measures across adult cardiac surgery and other fields. The panel subsequently developed methodology and selected measures for a congenital heart surgery composite measure and reviewed potential advantages and limitations. Individual measures considered for potential inclusion in the composite were reviewed within the context of Donabedian's triad and the Institute of Medicine quality domains. Decisions were made through group consensus. RESULTS: The final composite measure selected is comprised of two domains: (1) a mortality domain (operative mortality) and (2) a morbidity domain (the 6 major complications endorsed by The Society of Thoracic Surgeons and Congenital Heart Surgeons Society plus cardiac arrest, and postoperative length of stay). Potential advantages include the more comprehensive view of quality compared with mortality alone and improvements in discrimination of hospital performance through increasing the number of end points. Potential limitations include the lack of longer term outcomes and challenges related to case-mix adjustment. CONCLUSIONS: We have applied and adapted conceptual framework and methodology related to composite quality measures across other fields to congenital heart surgery. The composite quality metric created is inclusive of both morbidity and mortality, and expands our view of quality in this patient population.
Authors: Eric D Peterson; Elizabeth R Delong; Frederick A Masoudi; Sean M O'Brien; Pamela N Peterson; John S Rumsfeld; David M Shahian; Richard E Shaw; David C Goff; Kathleen Grady; Lee A Green; Kathy J Jenkins; Ann Loth; Martha J Radford Journal: Circulation Date: 2010-03-29 Impact factor: 29.690
Authors: Punkaj Gupta; Sara K Pasquali; Jeffrey P Jacobs; Marshall L Jacobs; Xinyu Tang; Jeffrey M Gossett; J William Gaynor; Amy H Praestgaard; Stephen M Schexnayder; Robert A Berg; Vinay M Nadkarni Journal: Pediatr Crit Care Med Date: 2016-06 Impact factor: 3.624
Authors: Sara K Pasquali; Jeffrey P Jacobs; Xia He; Christoph P Hornik; Robert D B Jaquiss; Marshall L Jacobs; Sean M O'Brien; Eric D Peterson; Jennifer S Li Journal: Ann Thorac Surg Date: 2011-10-19 Impact factor: 4.330
Authors: Jeffrey Phillip Jacobs; Marshall Lewis Jacobs; Erle H Austin; Constantine Mavroudis; Sara K Pasquali; Francois G Lacour-Gayet; Christo I Tchervenkov; Hal Walters; Emile A Bacha; Pedro J Del Nido; Charles D Fraser; J William Gaynor; Jennifer C Hirsch; David L S Morales; Kamal K Pourmoghadam; James S Tweddell; Richard L Prager; John E Mayer Journal: World J Pediatr Congenit Heart Surg Date: 2012-01-01
Authors: Sara K Pasquali; Xia He; Jeffrey P Jacobs; Marshall L Jacobs; Michael G Gaies; Samir S Shah; Matthew Hall; J William Gaynor; Eric D Peterson; John E Mayer; Jennifer C Hirsch-Romano Journal: Ann Thorac Surg Date: 2015-01-24 Impact factor: 4.330
Authors: Sara K Pasquali; Amelia S Wallace; J William Gaynor; Marshall L Jacobs; Sean M O'Brien; Kevin D Hill; Michael G Gaies; Jennifer C Romano; David M Shahian; John E Mayer; Jeffrey P Jacobs Journal: Ann Thorac Surg Date: 2016-07-22 Impact factor: 4.330
Authors: Karl F Welke; Sean M O'Brien; Eric D Peterson; Ross M Ungerleider; Marshall L Jacobs; Jeffery P Jacobs Journal: J Thorac Cardiovasc Surg Date: 2009-03-17 Impact factor: 5.209
Authors: Marshall L Jacobs; Sean M O'Brien; Jeffrey P Jacobs; Constantine Mavroudis; Francois Lacour-Gayet; Sara K Pasquali; Karl Welke; Christian Pizarro; Felix Tsai; David R Clarke Journal: J Thorac Cardiovasc Surg Date: 2012-07-24 Impact factor: 5.209
Authors: Sean M O'Brien; Jeffrey P Jacobs; Sara K Pasquali; J William Gaynor; Tara Karamlou; Karl F Welke; Giovanni Filardo; Jane M Han; Sunghee Kim; David M Shahian; Marshall L Jacobs Journal: Ann Thorac Surg Date: 2015-08-03 Impact factor: 4.330
Authors: Rodney C G Franklin; Jeffrey Phillip Jacobs; Otto N Krogmann; Marie J Béland; Vera D Aiello; Steven D Colan; Martin J Elliott; J William Gaynor; Hiromi Kurosawa; Bohdan Maruszewski; Giovanni Stellin; Christo I Tchervenkov; Henry L Walters Iii; Paul Weinberg; Robert H Anderson Journal: Cardiol Young Date: 2008-12 Impact factor: 1.093
Authors: Monique M Gardner; Garrett Keim; Jill Hsia; Anh D Mai; J William Gaynor; Andrew C Glatz; Nadir Yehya Journal: J Am Heart Assoc Date: 2022-06-14 Impact factor: 6.106
Authors: Philip Allen; Farhan Zafar; Junhui Mi; Sarah Crook; Joyce Woo; Natalie Jayaram; Roosevelt Bryant; Tara Karamlou; James Tweddell; Kacie Dragan; Stephen Cook; Edward L Hannan; Jane W Newburger; Emile A Bacha; Robert Vincent; Khanh Nguyen; Kathleen Walsh-Spoonhower; Ralph Mosca; Neil Devejian; Steven A Kamenir; George M Alfieris; Michael F Swartz; David Meyer; Erin A Paul; John Billings; Brett R Anderson Journal: J Am Coll Cardiol Date: 2022-02-08 Impact factor: 24.094
Authors: Omar Toubat; Demetrios N Mallios; Naikhoba C O Munabi; William P Magee; Vaughn A Starnes; S Ram Kumar Journal: World J Pediatr Congenit Heart Surg Date: 2021-01
Authors: Tara C Cosgrove; Lauren N Carlozzi; Kevin F Dolan; Sean P Gleeson; Lanette L Johnson; Steven C Cassidy; Robert J Gajarski Journal: Pediatr Qual Saf Date: 2021-12-15
Authors: Uri Pollak; Yael Feinstein; Candace N Mannarino; Mary E McBride; Malaika Mendonca; Eitan Keizman; David Mishaly; Grace van Leeuwen; Peter P Roeleveld; Lena Koers; Darren Klugman Journal: Front Pediatr Date: 2022-09-16 Impact factor: 3.569
Authors: Timothy E Nissen; Isabella Zaniletti; R Thomas Collins; Lawrence E Greiten; Parthak Prodhan; Paul M Seib; Elijah H Bolin Journal: Pediatr Cardiol Date: 2021-07-30 Impact factor: 1.655