Congenital Cardiac Catheterization Projects on Outcomes - Quality Improvement (C3PO-QI)

Doctor's Name: 
Lisa Bergersen, MD, MPH
Hospital/Institution: 
Boston Children's Hospital

In this proposal, the multi-center Congenital Cardiac Catheterization Project on Outcomes – Quality Improvement (C3PO-QI) collaborative plans to provide generalizable tools to hospitals nationwide to inform improvements in catheterization for children with congenital heart disease. Our project seek to improve the quality of care offered to patients by providing robust tools to operators  to enhance their daily practices and understanding of radiation exposure, adverse events, and patient flow. 

We plan to first define congenital heart disease catheterization procedure types with similar expected radiation exposure to create radiation risk assessment standards for the field. Congenital heart disease patients often undergo extensive, and in many cases, multiple catheterization procedures, resulting in high cumulative radiation exposure. Institutional comparisons of radiation exposure to published radiation dose metrics remains limited by a lack of case mix complexity standards and an assessment of safety performance. It is vital to develop robust risk stratification methodology to account for the substantial variation in radiation use that exists between different institutions. This work will provide a practical tool for providers to allow them to compare their institutional and operator outcomes to those of other centers for a multitude of procedures with different observed radiation exposure.

Our second aim is to build upon and update the collaborative’s previously established risk adjustment model for adverse outcomes, the Congenital Heart Adjustment for Risk Method (CHARM). The original CHARM model, with financial support from the Children’s Heart Foundation in 2011, established baseline adverse event rates and allowed for the equitable comparison of outcomes. The model was endorsed by the National Quality Forum (NQF) as the first and only quality metric to date in pediatrics for catheterization. We plan to update the model with contemporary procedure types and variables to reflect changes in the field of congenital heart disease and to provide operators with a useful and effective tool to access adverse outcomes and improve patient care. 

In addition, we will develop a tool to inform capacity management for high volume, high acuity patients with congenital heart disease undergoing catheterization procedures. Currently, there is no prediction tool available to assist catheterization lab staff in balancing high-risk, complex cases throughout the week to allow for calculated and accurate resource allocation and improved capacity management. We believe our work in this area will increase patient safety by allowing anticipated risk predictions to guide the staff in making informed decisions on patient flow in the catheterization lab, as well as providing patients and their families with information regarding their course of care. 

The previous financial support received from The Children’s Heart Foundation helped launch the C3PO-QI project, which has allowed us to contribute meaningful work to the field of congenital heart disease. We hope to continue our efforts in improving patient safety and the quality of care delivered with the proposed projects in this grant application. 

Award Date 1: 
2017
Award Amount 1: 
$40,000