“Developing a National Model for Regionalization of Care for Children Undergoing Congenital Cardiac Surgery in the United States”

Doctor's Name: 
Welke, Karl MD, MS
Children's Hospital of Illinois ( Peoria )

While outcomes for children born with congenital heart defects have improved over the past 3 decades, up to 20% of children with some severe heart defects still die after surgery.  In addition, surgical results at all hospitals are not the same.  This suggests that improvements could be made so children could expect to have good results regardless of where they are treated.  Pediatric heart surgery requires extensive resources and a skilled, specialized team and compared to many other types of surgery, is a relatively rare event.  The combination of these factors makes it difficult for smaller hospitals to achieve the results as larger hospitals where resources can be shared by a larger number of patients and surgical teams can treat enough children to maintain their skills. One important factor in determining the quality of care for children who undergo surgery is the number of operations done at a hospital.  In general, fewer children die at hospitals where more operations are done.  Several countries, including Sweden, the Netherlands, and the United Kingdom, have proposed or developed regionalized systems in which children with congenital heart disease are treated only at a select group of high volume, high quality hospitals.  This has resulted in less variation in surgical results and improved overall quality of care. In the case of Sweden, the results were quite dramatic with 80% fewer children dying after heart surgery compared to before the change.

In the US, there are more than 300 hospitals performing pediatric heart surgery, the majority of which do small numbers of operations.  However, the current economic environment is such that hospital consolidations are increasing.  As health care reform reduces reimbursements and encourages hospitals to coordinate care, larger health care systems benefit from the economy of scale.  As hospitals merge in order to maintain the ability to provide quality care and remain economically viable, regionalization of services such as congenital heart surgery becomes attractive.  A system that regionalizes care for congenital heart surgery across the US has not been described or explored.  Specifically, the number and location of programs, travel distances to regionalized hospitals for patients and families and the degree to which this type of system may be anticipated to improve outcomes for children undergoing heart surgery is unclear. This study will be a critical first step in characterizing the present structure of congenital heart surgery services in the US, and will begin the discussion about how it would best be structured going forward.

The goal of the proposed study is to simulate a national regionalized system of hospitals for this complex patient population that improves outcomes while minimizing burdens on patients and their families.  Our proposal has the following aims:

Aim 1:  To define the current network of hospitals providing surgery for patients with congenital heart disease in the United States.

We will identify and map hospitals currently operating on children with congenital heart disease.

Aim 2:  To develop a simulation model which would consolidate congenital heart surgery to larger regional hospitals. 

Based on the location and volume of current hospitals performing congenital heart surgery, estimates of birth rates and the prevalence of congenital heart disease, we will model a regionalized system of care, and describe the number and location of hospitals in this system.  We will also calculate travel times for patients and their families to these regionalized centers under this new model.

Aim 3:  To explore the potential impact of regionalization on mortality rates after congenital heart surgery.

We will develop models to estimate the potential number of lives saved by consolidating care to high volume, regional hospitals.

The information generated from this proposal will have immediate value to multiple stakeholders aiming to reduce variation in outcomes in this population and improve quality of care on a national level.  We project that a fully implemented regionalized system could reduce the number of children dying after heart surgery by at least several hundred each year.

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