Access the Final Report: National Voluntary Consensus Standards for Pediatric Cardiac Surgery: A Consensus Report
The Opportunity
Heart defects are among the most common birth defects and are the leading cause of birth-defect-related deaths1 ; approximately 35,000 infants (one out of 125) are born with heart defects each year in the U.S. Other children will develop acquired heart disease, including such conditions as arrhythmias, cardiomyopathies, Kawasaki disease, and rheumatic fever. Due to advances in diagnosis and surgical treatment of these children, the mortality rate related to surgery has decreased dramatically from 30 percent in the 1960s and 1970s to around 4 percent today.
However, a retrospective cohort study from 1992 to 1996 revealed that children with Medicaid insurance have a higher risk of dying after congenital heart surgery than those with commercial and some managed care insurance, likely due to care access barriers and differential referral patterns.2 This is significant, as more than 20 million (25 percent) of children in the U.S. rely on Medicaid and SCHIP for health insurance coverage. Survivors—approximately 96 percent of all patients—experience morbidities that seriously impact their quality of life, that of their families, and healthcare consumption and costs borne by society as a whole. Annual charges for inpatient congenital cardiac surgery now exceed $2.2 billion.3
About the Project
In May of 2009 NQF began a project to endorse measures for pediatric cardiac surgery. Performance measurement for healthcare quality reporting and improvement have to date focused largely on the adult population, but there is growing interest and momentum to include pediatric measures in these efforts.
NQF has previously endorsed measures specific to adult cardiac surgery, pediatric heart surgery volume, and pediatric heart surgery mortality. Quality improvement strategies for pediatric cardiac surgery will benefit from specific measures aimed at further reduction of mortality, efficient use of resources, and reduction of morbidities.
Objectives
This project seeks to identify and endorse measures for public reporting and quality improvement related to pediatric cardiac surgery processes, structure, and patient outcomes. It will establish national, multi-stakeholder voluntary consensus on current performance standards that are ready for immediate implementation, as well as on recommendations for priority areas for research and measure development.
Process
Candidate measures will be considered for NQF endorsement as national voluntary consensus standards. Agreement will be developed through NQF’s Consensus Development Process (CDP). This project involves the active participation of representatives from across the spectrum of healthcare stakeholders and will be guided by a steering committee.
Funding
Funding for this project has been provided by Pediatric Cardiac Surgery Coalition.
Related NQF Work
Contact Information
For more information contact Ashlie Wilbon, RN, MPH at 202-783-1300 or pediatriccardiacsurgery@qualityforum.org.
Notes
1. Kochanek, K.D., et al. Deaths: Final Data for 2002. National Vital Statistics Reports, volume 53, number 5, October 12, 2004.
2. DeMone JA, Gonzalez PC, Gauvreau K, et al. Risk of Death for Medicaid Recipients Undergoing Congenital Heart Surgery. Pediatric Cardiology. 2006; 24 (2): 97-102.
3. American Heart Association. Available at: http://www.americanheart.org/presenter.jhtml?identifier=12012; Last Accessed May 4, 2007.
NQF seeks to endorse processes, structure, and outcome measures specific to pediatric cardiac surgery that are aimed at further reduction of mortality, efficient use of resources, and reduction of morbidities.
In response to the Call for Intent to Submit Candidate Standards, 26 proposed measures were identified as possible submissions.
The Call for Nominations closed on August 31, 2009. For more information on the committee formation process, please refer to the Call for Nominations document.
Call for Nominations (Word)
NQF issued a call for candidate performance measures relevant to the areas of medication management, outcomes, processes, treatment, and assessment of pediatric cardiac patients.
Table of Submitted Measures (PDF)
The Steering Committee will meet in person and by phone to review the submitted candidate measures. Meeting agendas and call-in information will be posted as available.
Pediatric Cardiac Surgery Steering Committee was open to NQF Members and public. It was held at Hyatt Regency Washington.
The Steering Committee met via conference call on May 17, 2010.
The Steering Committee is met via conference call on September 13, 2010. The committee reviewed the comments submitted during the public and member comment period.
Agenda (PDF)
Meeting Summary (PDF)
Meeting Recording (MP3)
Member voting closed on November 15, 2010 at 6:00 pm ET. Members had 30 days to submit their vote.
The draft report has been revised based on the comments received during
the Public and Member Comment and consultation with the Pediatric
Cardiac Surgery Steering Committee. Member voting closed on November 15, 2010 at 6:00pm ET.
CSAC held two meetings to review and consider the endorsement of Pediatric Cardiac Surgery measures.
CSAC met via conference call on January
10. During this meeting, they reviewed a summary of the recommended
measures. They also reviewed measures from the Surgical Endorsement Maintenance 2010 project.
The Board chose to ratify the two measures.
The public has 30 days to appeal the final decision to endorse a voluntary consensus standard. Any party may request reconsideration of the recommendations, in whole or in part, by notifying NQF by December 28 at 6:00pm ET.
To submit an appeal, go to the Measures List.
