Regionalization Or Access To Care? A Joint Program That Achieves Both
Carl L. Backer1, David A. Katz, MD2, Shaun Mohan, MD1, Matthew Bacon, MD1, Eimear McGovern, MD1, Geneva M. Preston, MD1, Louis Bezold, MD1, Scottie Day, MD1, Andrew N. Redington, MD2, James Quintessenza, MD1, James S. Tweddell, MD2.
1UK HealthCare Kentucky Children's Hospital, LEXINGTON, KY, USA, 2Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objective(s): Regionalization of care for children with congenital heart disease has been proposed as a method to improve outcomes. This has raised concerns about limiting access to care. We present the details of a joint pediatric heart care program (JPHCP) which utilizes regionalization without limiting access of care. Methods: In 2017, a JPHCP was launched. This was a unique model between a smaller university-based children's hospital, and a large volume congenital heart center that was 90 miles away. This model uses shared personnel, protocols, and a robust transport system. Results: Between March 2017 and June 2022, 401 operations were performed at the smaller site. There were two operative mortalities; an adult undergoing surgery for Ebstein anomaly, and a premature infant that died from severe lung disease five months after an aortopexy. There were 126 STAT 1 operations, 148 STAT 2, 40 STAT 3, and 36 STAT 4. STAT 5, complex neonates, and patients listed for heart transplant were referred to the large volume site. As of the most recent published Society of Thoracic Surgeons (STS) outcome report, the JPHCP outperformed the STS overall in postoperative length-of- stay, and the mortality rate was lower than expected for case mix. Conclusions: Creation of this JPHCP demonstrated that a smaller university-based children's hospital can achieve excellent congenital heart surgery results with a select case mix. This was accomplished by affiliating with a large volume congenital heart center. Importantly, access to care was significantly improved for those children at the more remote location.
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