Jenkins Kathy J, Castañeda Aldo R, Cherian K M, Couser Chris A, Dale Emily K, Gauvreau Kimberlee, Hickey Patricia A, Koch Kupiec Jennifer, Morrow Debra Forbes, Novick William M, Rangel Shawn J, Zheleva Bistra, Christenson Jan T
Boston Children's Hospital, Boston, Massachusetts;
Unidad de Cirugía Cardiovascular Pediátrica de Guatemala, Guatemala City, Guatemala;
Pediatrics. 2014 Nov;134(5):e1422-30. doi: 10.1542/peds.2014-0356. Epub 2014 Oct 13.
There is little information about congenital heart surgery outcomes in developing countries. The International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries uses a registry and quality improvement strategies with nongovernmental organization reinforcement to reduce mortality. Registry data were used to evaluate impact.
Twenty-eight sites in 17 developing world countries submitted congenital heart surgery data to a registry, received annual benchmarking reports, and created quality improvement teams. Webinars targeted 3 key drivers: safe perioperative practice, infection reduction, and team-based practice. Registry data were audited annually; only verified data were included in analyses. Risk-adjusted standardized mortality ratios (SMRs) and standardized infection ratios among participating sites were calculated.
Twenty-seven sites had verified data in at least 1 year, and 1 site withdrew. Among 15,049 cases of pediatric congenital heart surgery, unadjusted mortality was 6.3% and any major infection was 7.0%. SMRs for the overall International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries were 0.71 (95% confidence interval [CI] 0.62-0.81) in 2011 and 0.76 (95% CI 0.69-0.83) in 2012, compared with 2010 baseline. SMRs among 7 sites participating in all 3 years were 0.85 (95% CI 0.71-1.00) in 2011 and 0.80 (95% CI 0.66-0.96) in 2012; among 14 sites participating in 2011 and 2012, the SMR was 0.80 (95% CI 0.70-0.91) in 2012. Standardized infection ratios were similarly reduced.
Congenital heart surgery risk-adjusted mortality and infections were reduced in developing world programs participating in the collaborative quality improvement project and registry. Similar strategies might allow rapid reduction in global health care disparities.
关于发展中国家先天性心脏病手术结果的信息很少。发展中国家先天性心脏病国际质量改进协作组织利用一个登记系统和质量改进策略，并借助非政府组织的强化支持来降低死亡率。登记系统数据被用于评估影响。
17个发展中国家的28个机构向一个登记系统提交了先天性心脏病手术数据，收到年度基准报告，并组建了质量改进团队。网络研讨会针对3个关键驱动因素：安全的围手术期操作、感染控制和团队协作。登记系统数据每年进行审核；分析中仅纳入经核实的数据。计算参与机构的风险调整标准化死亡率（SMR）和标准化感染率。
27个机构在至少1年中有经核实的数据，1个机构退出。在15049例小儿先天性心脏病手术中，未调整的死亡率为6.3%，任何严重感染率为7.0%。与2010年基线相比，发展中国家先天性心脏病国际质量改进协作组织总体的SMR在2011年为0.71（95%置信区间[CI]0.62 - 0.81），在2012年为0.76（95%CI 0.69 - 0.83）。在所有3年都参与的7个机构中，SMR在2011年为0.85（95%CI 0.71 - 1.00），在2012年为0.80（95%CI 0.66 - 0.96）；在2011年和2012年参与的14个机构中，2012年的SMR为0.80（95%CI 0.70 - 0.91）。标准化感染率也同样降低。
参与协作质量改进项目和登记系统的发展中国家项目中，先天性心脏病手术的风险调整死亡率和感染率有所降低。类似策略可能会使全球医疗保健差距迅速缩小。
