Use of a learning network to improve variation in interstage weight gain after the Norwood operation.

Abstract

BACKGROUND:

Growth failure is common in infants with single ventricle. This study evaluated the use of a learning network, the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC), to spread optimized nutritional practices and improve infant growth.

METHODS:

A previously identified Nutritional Bundle was spread among NPC-QIC sites.

PRIMARY OUTCOME:

interstage weight-for-age z-score change (ΔWAZ) between discharge from stage 1 palliation (S1) and stage 2 surgical palliation (S2). Variation among sites in interstage ΔWAZ was evaluated before (Period 1) and after (Period 2) spread of Nutritional Bundle. We performed an analysis of NPC-QIC registry infants presenting for S2 at sites previously shown to have significant variation in interstage patient growth.

RESULTS:

Four hundred seven infants from 15 sites underwent S2 between 2008 and 2013: 158 in Period 1 (December 2008-December 2010) and 249 in Period 2 (December 2010-April 2013). Median age at S2 was 4.9 months (2.6-12.8) with no difference between periods. There was significant variation in interstage ΔWAZ among sites in Period 1 (P = .01) but not in Period 2 (P = .39). More patients had an interstage ΔWAZ <0 in Period 1 (43%) than Period 2 (32%) (P = .03). In Period 1, the median interstage ΔWAZ was <0 in six sites while in Period 2 no site had median interstage ΔWAZ <0. Sites with the worst patient growth in Period 1 had marked improvement in Period 2 (P = .02, .06, and .06, respectively).

CONCLUSIONS:

Spread of optimal nutritional practices led to decreased variation in interstage growth with most improvement observed at sites with the worst baseline growth outcomes.

• Authors: Jeffrey B Anderson, Robert H Beekman 3rd, John D Kugler, Geoffrey L Rosenthal, Kathy J Jenkins, Thomas S Klitzner, Gerard R Martin, Steven R Neish, Lynn Darbie, Eileen King, Carole Lannon, National Pediatric Cardiology Quality Improvement Collaborative
• Journal: Congenital heart disease (Congenit Heart Dis) 2014 Nov-Dec Vol. 9 Issue 6 Pg. 512-20 ISSN: 1747-0803 [Electronic] United States
• PMID: 25358553 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
• Copyright: © 2014 Wiley Periodicals, Inc.

Topics

• Bottle Feeding (standards)
• Breast Feeding
• Cooperative Behavior
• Education, Medical, Continuing (standards)
• Female
• Humans
• Hypoplastic Left Heart Syndrome (diagnosis, physiopathology, surgery)
• Infant
• Infant Formula (standards)
• Infant, Newborn
• Male
• Norwood Procedures (adverse effects, standards)
• Nutrition Assessment
• Nutritional Status
• Patient Care Team (standards)
• Practice Patterns, Physicians' (standards)
• Quality Improvement (standards)
• Quality Indicators, Health Care (standards)
• Registries
• Retrospective Studies
• Time Factors
• Treatment Outcome
• United States
• Weight Gain