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Joint programmes in paediatric cardiothoracic surgery: a survey and descriptive analysis

Published online by Cambridge University Press:  13 December 2011

William M. DeCampli
William M. DeCampli*
Affiliation:
University of Central Florida College of Medicine, Orlando, Florida, United States of America Division of Pediatric Cardiothoracic Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, United States of America
*
Correspondence to: Dr W. M. DeCampli, MD, PhD, Division of Pediatric Cardiothoracic Surgery, Arnold Palmer Hospital for Children, 50 East Miller Street, Orlando, Florida 32813, United States of America. Tel: +321 843 3294; Fax: +407 539 3068; E-mail: William.decampli@orlandohealth.com
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Abstract

Background

Joint programmes, as opposed to regionalisation of paediatric cardiac care, may improve outcomes while preserving accessibility. We determined the prevalence and nature of joint programmes.

Methods

We sent an online survey to 125 paediatric cardiac surgeons in the United States in November, 2009 querying the past or present existence of a joint programme, its mission, structure, function, and perceived success.

Results

A total of 65 surgeon responses from 65 institutions met the criteria for inclusion. Of the 65 institutions, 22 currently or previously conducted a joint programme. Compared with primary institutions, partner institutions were less often children's hospitals (p = 0.0004), had fewer paediatric beds (p = 0.005), and performed fewer cardiac cases (p = 0.03). Approximately 47% of partner hospitals performed fewer than 50 cases per year. The median distance range between hospitals was 41–60 miles, ranging from 5 to 1000 miles. Approximately 54% of partner hospitals had no surgeon working primarily on-site, and 31% of the programmes conducted joint conferences. Approximately 67% of the programmes limited the complexity of cases at the partner hospital, and 83% of the programmes had formal contracts between hospitals. Of the six programmes whose main mission was to increase referrals to the primary hospital, three were felt to have failed. Of the nine programmes whose mission was to increase regional quality, eight were felt to be successful.

Conclusion

Joint programmes in paediatric cardiac surgery are common but are heterogeneous in structure and function. Programmes whose mission is to improve the quality of regional care seem more likely to succeed. Joint programmes may be a practical alternative to regionalisation to achieve better outcomes.

Keywords

Cardiac surgeryregionalisation of carehealth-care modelsoutcomesquality improvement
Type
Original Article
Information
Cardiology in the Young , Volume 21 , Issue S2: A Holistic Approach to Hypoplastic Left Heart Syndrome and other evolving challenges in Pediatric and Congenital Cardiac Disease , 13 December 2011 , pp. 159 - 164
Copyright
Copyright © Cambridge University Press 2011

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