A Failed Cardiac Surgery Program in an Underserved Minority Population County Reimagined: The Power of Partnership.
Author
Brown, James MHajjar-Nejad, M J
Dominique, Guerda
Gillespie, Malinda
Siddiqi, Imran
Romine, Heather
Odonkor, Patrick
Dawood, Murtaza
Gammie, James S
Date
2020-11-20Journal
Journal of the American Heart AssociationPublisher
American Heart AssociationType
Article
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Background Prince George's County Maryland, historically a medically underserved region, has a population of 909 327 and a high incidence of cardiometabolic syndrome and hypertension. Application of level I evidence practices in such areas requires the availability of highly advanced cardiovascular interventions. Donabedian principles of quality of care were applied to a failing cardiac surgery program. We hypothesized that a multidisciplinary application of this model supported by partnership with a university hospital system could result in improved quality care outcomes. Methods and Results A 6-month assessment and planning process commenced in July 2014. Preoperative, intraoperative, and postoperative protocols were developed before program restart. Staff education and training was conducted via team simulation and rehearsal sessions. A total of 425 patients underwent cardiac surgical procedures. Quality tracking of key performance measures was conducted, and 323 isolated coronary artery bypass grafting procedures were performed from July 2014 to December 2019. Key risk factors in our patient demographic were higher than the Society of Thoracic Surgeons national mean. Risk-adjusted outcome data yielded a mortality rate of 0.3% versus 2.2% nationally. The overall major complication rate was lower than expected at 7.1% compared with 11.5% nationally. Readmission rate was less than the Society of Thoracic Surgeons mean for isolated coronary artery bypass grafting (4.0% versus 10.1%, P<0.0001). Significant differences in 6 key performance outcomes were noted, leading to a 3-star Society of Thoracic Surgeons designation in 7 of 8 tracking periods. Conclusions Excellent outcomes in cardiac surgery are attainable following program renovation in an underserved region in the setting of low volume. The principles and processes applied have potential broad application for any quality improvement effort.Keyword
Donabedian triadcoronary artery bypass grafting
health disparities
health outcomes
partnership model
patient‐centric process maps
quality improvement
Identifier to cite or link to this item
http://hdl.handle.net/10713/14203ae974a485f413a2113503eed53cd6c53
10.1161/JAHA.120.018230
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