Development of a Congenital Heart Surgery Composite Quality Metric: Part 1—Conceptual Framework

Abstract

We have applied and adapted conceptual framework and methodology related to composite quality measures across other fields to congenital heart surgery. The composite quality metric created is inclusive of both morbidity and mortality, and expands our view of quality in this patient population.

Development of a Congenital Heart Surgery Composite Quality Metric: Part 2—Analytic Methods

“…The postoperative complications included (described further in Part 1) are listed in Table 1 [1]. The STS-CHSD includes complications occurring during the same hospitalization as the operation or after discharge within 30 days of the operation.…”

“…This approach can be thought of as analogous in concept to “freedom from major complications” for patients who did not experience any of the complications. Alternative approaches were also discussed (see Part 1), and it was agreed that weighting complications in relation to their effect on longer-term survival or quality of life would be desirable; however, adequate data in this area do not currently exist [1]. Efforts are underway to better capture these data moving forward [4].…”

“…The rationale for including postoperative LOS in addition to major complications is described in Part 1 [1]. For analytic purposes, LOS was defined as 1 plus the number of days between the date of the operation and discharge, which facilitates modeling by ensuring LOS is never 0.…”

“…Current quality measures focus primarily on operative mortality, which has several limitations. As described in detail in Part 1 of this report, these include its unidimensional nature and limited ability to discriminate hospital performance due to low overall event rates in the current era [1]. …”

“…Part 1 of this report detailed the background, rationale, and conceptual framework related to the development of the first composite quality metric in pediatric and congenital heart surgery [1]. In this report (Part 2), we describe the statistical methods and results.…”