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Identifying best practices in interstage care: using a positive deviance approach within the National Pediatric Cardiology Quality Improvement Collaborative

Published online by Cambridge University Press:  26 February 2019

Katherine E. Bates ,
Sunkyung Yu ,
Colleen Mangeot ,
Judy A. Shea ,
David W. Brown  and
Karen Uzark
Katherine E. Bates*
Affiliation:
Division of Pediatric Cardiology, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor, MI, USA
Sunkyung Yu
Affiliation:
Division of Pediatric Cardiology, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor, MI, USA
Colleen Mangeot
Affiliation:
Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Judy A. Shea
Affiliation:
Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
David W. Brown
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
Karen Uzark
Affiliation:
Division of Pediatric Cardiology, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor, MI, USA Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
*
Author for correspondence: Katherine E. Bates, MD, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, 1540 E. Hospital Drive, Ann Arbor, MI 48109-4204, USA. Tel: 734-232-8426; Fax: 734-936-4628; E-mail: kebates@med.umich.edu
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Abstract

Introduction

To identify interstage best practices associated with lower mortality, we studied National Pediatric Cardiology Quality Improvement Collaborative centres registry using a positive deviance approach.

Methods

Positive deviant and control centre team members were interviewed to identify potential interstage best practices. Subsequently, all collaborative centres were surveyed on the use of these practices to test their associations with centre mortality. Questionnaires were scored using Likert scales; the overall score was linearly transformed to a 0–100-point scale with higher scores indicating increased use of practices. Mortality was based on patients enrolled after a centre’s first year in the collaborative. Centre mortality rates were divided into tertiles. Survey scores for the low mortality tertile were compared with the other tertiles.

Results

For this study, seven positive deviant and four control teams were interviewed. A total of 20 potential best practices were identified, including team composition, improvement practices, and parent involvement. Questionnaires were completed by 36/43 eligible centres, providing 1504 patients for analysis. Average survey score was 50.2 (SD 13.4). Average mortality was 6.1% (SD 4.1). There was no correlation between survey scores and mortality (r=0.14, p=0.41). The one practice associated with the low mortality tertile was frequency of discussion of interstage results: 58.3% of low mortality teams discussed results at least monthly versus 8.4% of the middle and high tertile centres (p=0.02).

Conclusions

Low-mortality centres more frequently discuss interstage results than high-mortality centres. Heightened awareness of outcomes may influence practice; however, further study is needed to understand the variation in outcomes across centres.

Keywords

Hypoplastic low heart syndromeCHDNorwood operation
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 398 - 407
Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Bates KE, Yu S, Mangeot C, Shea JA, Brown DW, Uzark K. (2019). Identifying best practices in interstage care: using a positive deviance approach within the National Pediatric Cardiology Quality Improvement Collaborative. Cardiology in the Young29: 398–407. doi: 10.1017/S1047951118002548

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