Ali Fatima, Qasim Mehdi Mohammad, Akhtar Saleem, Aslam Nadeem, Abbas Rashid, Shah Izat, Abidi Jabbir, Arthur Sajid, Nizar Zeenat, Goodmann Andrea, Bergersen Lisa, Hasan Babar
Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan.
Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
Heart Asia. 2019 Jan 10;11(1):e011105. doi: 10.1136/heartasia-2018-011105. eCollection 2019.
The importance of registries for collaborative quality improvement has been overlooked in low/middle-income countries (LMIC). Aga Khan University Hospital (AKUH) in Pakistan joined the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in March 2017 with the goal of leveraging international collaboration to improve patient care and institutional standards.
The C3PO-QI key driver-based approach was used, with certain modifications, for process re-engineering in AKUH's congenital cardiac catheterisation laboratory (CCL) to reduce radiation exposure during cardiac catheterisation procedures (the primary outcome of C3PO- QI). Educating staff and standardising procedural documentation were the principal goals of the process re-engineering. Data survey was used to assess staff knowledge, attitude and practice before and after the initiative. Additionally, case demographics and outcomes were compared between AKUH and C3PO-QI centres.
There was an increase in appropriate recording of radiation surrogates (0%-100%, p=0.00) and in the percentage of cases that met the established benchmark of 'Ideal documentation' (35% vs 95%, p=0.001). There was also an increase in self-reported staff interest during the case (25% vs 75%, p=0.001). AKUH versus C3PO-QI data showed similar demographic characteristics. There was a slight over-representation of diagnostic cases (42% vs 32%) as compared with interventional (58% vs 68%) at AKUH. Furthermore, interventional procedures were predominately PDA and ASD device closures (n=19 and 15, respectively). The frequency of adverse events were the same between AKUH and collaborative sites.
Collaborative efforts between developed and LMIC CCL are significant in advancing system-level processes.
在低收入/中等收入国家（LMIC），用于协作性质量改进的登记系统的重要性一直被忽视。巴基斯坦的阿迦汗大学医院（AKUH）于2017年3月加入了先天性心脏导管插入术结果-质量改进项目（C3PO-QI），目标是利用国际合作来改善患者护理和机构标准。
采用C3PO-QI基于关键驱动因素的方法，并做了某些修改，用于AKUH先天性心脏导管插入实验室（CCL）的流程再造，以减少心脏导管插入术过程中的辐射暴露（C3PO-QI的主要结果）。对工作人员进行培训并使程序文档标准化是流程再造的主要目标。通过数据调查来评估该举措实施前后工作人员的知识、态度和实践情况。此外，还比较了AKUH与C3PO-QI中心的病例人口统计学特征和结果。
辐射替代指标的适当记录有所增加（从0%增至100%，p = 0.00），达到“理想文档”既定基准的病例百分比也有所增加（从35%增至95%，p = 0.001）。在病例过程中，自我报告的工作人员兴趣也有所增加（从25%增至75%，p = 0.001）。AKUH与C3PO-QI的数据显示出相似的人口统计学特征。与介入性病例（58%对68%）相比，AKUH的诊断性病例略有超比例（42%对32%）。此外，介入性手术主要是动脉导管未闭和房间隔缺损封堵术（分别为n = 19和15）。AKUH与协作站点之间不良事件的发生率相同。
发达国家和低收入/中等收入国家的CCL之间的合作努力对于推进系统层面的流程具有重要意义。
