Upcoming CHSS Study examines the attributes of high-performing 'low-volume' congenital heart surgery programs
Christopher Caldarone, MD
Heart Center Organizational Design/Optimization and Leadership Enablement
Recent debates comparing quality in low-volume vs high-volume congenital heart programs are increasingly adversarial - and are focusing on the wrong question.
Rather than ask the overly simplistic question: “Which type of program is better?”, we should be studying high-performing programs to learn how they achieve high-quality outcomes. Examination of publicly reported data demonstrates that some low-volume programs consistently outperform high-volume programs in risk-adjusted comparisons. Therefore, the question we should be asking is: What are the attributes associated with superior performance in low-volume congenital heart programs?
The Congenital Heart Surgeons Society (CHSS) is taking a leadership role with an exciting study to better understand how some low-volume programs consistently perform so very well. Addressing this question will provide important information that can help to improve care in all programs.
The CHSS Quality and Outcomes Committee is leading this project with generous funding from the Brett Boyer Foundation. The Committee will focus on the 38 programs that perform between 75-200 STS index cases per year. This volume range is cited in a recent multi-society manuscript describing these centers as ‘Essential Care Centers’ (Backer et al; Recommendations for centers performing pediatric heart surgery in the United States. J Thor Cardiovasc Surg (166) 6, 2023 pp 1782-1820).
To tackle our research question, the CHSS Quality and Outcomes Committee will examine two types of data:
1. Conventional attributes will focus on easily measurable and widely recognized variables commonly cited in studies of this sort. Examples include the organizational characteristics of the ICU, nursing staffing ratios, perfusion practices, ECMO availability, surgeon experience, anesthesia coverage, and cardiology programmatic support etc… This quantitative data can be analyzed using standard statistical techniques.
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2. Unconventional attributes that the Committee feels are likely to be important include examination of the relationship between the clinical teams and the hospital administration, stability of the clinical team (e.g. ‘revolving door’ or consistent team), availability of shared discretionary funds available for the heart program leadership, core competencies of high performing teams (trust, common purpose, shared consciousness, empowered execution) etc… These qualitative data will be obtained through a structured interview process with participating clinical leaders led by Erle Austin (a trusted colleague and past-President of the CHSS).
The CHSS Quality and Outcomes Committee is heavily engaged in getting this project off the ground and includes (alphabetically) Petros Anagnostopoulos, Robert Dabal, Bill Douglas, Kristine Guleserian, Jeremy Herrmann, Jeff Jacobs, Jim Kirklin, Sara Pasquali, Jim St Louis, and Ram Subramanyan. Michael-Alice Moga serves as the committee’s liaison with the CHSS Center for Research and Quality. The project’s organization and execution is being led by Karl Welke who has a long history of publications focused on quality in surgical outcomes.
This exciting initiative is an example of how the CHSS is constantly seeking ways to improve care for our patients. If we can identify the attributes associated with superior performance in low-volume programs, we can share the information and improve care across the board. More to come!
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Skipper
7 个月Happy to participate I suggested to Ram we should invite the examiner to spend at least a day. So much to learn We are happy to shoulder the cost
MS4 at Shifa | Clinical Research Enthusiast | USMLE Aspirant | Aspiring General Surgeon.
7 个月Concepts of variability and potential of low volume congenital hearts programs are something to ponder upon. A study on the actual success factors of such programs may prove very informative and could possibly improve the results even of such well-endowed programs as those carried out by specialized centers. This approach is also helpful in moving strategy debate beyond overall quantities to performance and underlines the need for elaborate approaches to healthcare improvement. Anticipating for the result from the CHSS study and hopefully it will bring positive changes in enhancing congenital heart care in the world.
SPEAKER | STRATEGY COACH | FOUNDER + ADVOCATE
8 个月Yes, WHY are they achieving excellent outcomes? And what can other centers, both those with high and low volume learn from them? And then it would be interesting to know if the excellent high volume and low volume centers have the same attributes. Thanks for sharing.
Professor at Baylor College of Medicine
8 个月Having worked in both low-middle sized excellent programs and very large high performing programs, I would hypothesize that consistent personnel with experience led by an excellent surgical team is the key. It’s not the program or size, it’s the people. Great anesthesia, cardiology, critical care, nursing and support can’t make a bad repair better but does keep a good to excellent repair from going off the rails.
Clinically Retired/Cognitively Active. Emeritus Professor. Husband, Father, Grandfather, Musician, Volunteer. Stuff: Pediatric Cardiologist/Intensivist. CHD Research-Neurodevelopment/ICU USA & Club Gold Medals-Ultimate
8 个月What is co-linear w high volume? Some of the answer may be there. Nursing staff retention? Redundancy in depth of staff in OR, ICU, Cath, Anesthesia? Niche programs such as coronary, valve, pulmonary veins-not just for the diseases they treat but for the systems in place to sustain them…. I suppose it is what GOES ALONG with volume, as well as case volume itself Chris. Hope you’re well.