ObjectiveASSIST is the first Brazilian initiative in building a collaborative quality
improvement program in pediatric cardiology and congenital heart disease.
The purposes of this manuscript are:(a) to describe the development of the ASSIST project, including the
historical, philosophical, organizational, and infrastructural
components that will facilitate collaborative quality improvement in
congenital heart disease care;(b) to report past and ongoing challenges faced; and(c) to report the first preliminary data analysis.MethodsA total of 614 operations were prospectively included in a comprehensive
online database between September 2014 and December 2015 in two
participating centers. Risk Adjustment for Congenital Heart Surgery (RACHS)
1 and Aristotle Basic Complexity (ABC) scores were obtained. Descriptive
statistics were provided, and the predictive values of the two scores for
mortality were calculated by multivariate logistic regression models.ResultsMany barriers and challenges were faced and overcome. Overall mortality was
13.4%. Independent predictors of in-hospital death were: RACHS-1 categories
(3, 4, and 5/6), ABC level 4, and age group (≤ 30 days, and 30 days -
1 year).ConclusionThe ASSIST project was successfully created over a solid base of
collaborative work. The main challenges faced, and overcome, were lack of
institutional support, funding, computational infrastructure, dedicated
staff, and trust. RACHS-1 and ABC scores performed well in our case mix. Our
preliminary outcome analysis shows opportunities for improvement.