Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries

The care for patients with congenital heart disease (CHD) is multi-disciplinary and resource intensive. There is limited information about the infrastructure available among programs that care for CHD patients in low and middle-income countries (LMIC). A survey covering the entire care-pathway for C...

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Autores principales:	Isaac Wamala, Russell Gongwer, Kaitlin Doherty-Schmeck, Maria Jorina, Anne Betzner, Bistra Zheleva, Kimberlee Gauvreau, Christopher W. Baird, Kathy Jenkins
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2021
Materias:	congenital heart surgery infrastructure surgical capacity Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/914211250ab74d55bd8ad95eb958a4eb
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spelling	oai:doaj.org-article:914211250ab74d55bd8ad95eb958a4eb2021-11-08T08:07:55ZInfrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries2211-817910.5334/gh.968https://doaj.org/article/914211250ab74d55bd8ad95eb958a4eb2021-10-01T00:00:00Zhttps://globalheartjournal.com/articles/968https://doaj.org/toc/2211-8179The care for patients with congenital heart disease (CHD) is multi-disciplinary and resource intensive. There is limited information about the infrastructure available among programs that care for CHD patients in low and middle-income countries (LMIC). A survey covering the entire care-pathway for CHD, from initial assessment to inpatient care and outpatient follow-up, was administered to institutions participating in the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC). Surgical case complexity-mix was collected from the IQIC registry and estimated surgical capacity requirement was based on population data. The statistical association of selected infrastructure with case volume, case-complexity and percentage of estimated case-burden actually treated, was analyzed. Thirty-seven healthcare institutions in seventeen countries with median annual surgical volume of 361 (41–3503) operations completed the survey. There was a median of two (1–16) operating room/s (OR), nine (2–80) intensive care unit (ICU) beds, three (1–20) cardiac surgeons, five (3–30) OR nurses, four (2–35) anesthesiologists, four (1–25) perfusionists, 28 (5–194) ICU nurses, six (0–30) cardiologists and three (1–15) interventional cardiologists. Higher surgical volume was associated with higher OR availability (p = 0.007), number of surgeons (p = 0.002), OR nurses (0.008), anesthesiologists (p = 0.04), perfusionists (p = 0.001), ICU nurses (p < 0.001), years of experience of the most senior surgeon (p = 0.03) or cardiologist (p = 0.05), and ICU bed capacity (p = 0.001). Location in an upper-middle income country (P = 0.04), OR availability (p = 0.02), and number of cardiologists (p = 0.004) were associated with performing a higher percentage of complex cases. This study demonstrates an overall deficit in the infrastructure available for the care of CHD patients among the participating institutions. While there is considerable variation across institutions surveyed, deficits in infrastructure that requires long-term investment like operating rooms, intensive care capacity, and availability of trained staff, are associated with reduced surgical capacity and access to CHD care.Isaac WamalaRussell GongwerKaitlin Doherty-SchmeckMaria JorinaAnne BetznerBistra ZhelevaKimberlee GauvreauChristopher W. BairdKathy JenkinsUbiquity Pressarticlecongenital heart surgeryinfrastructuresurgical capacityDiseases of the circulatory (Cardiovascular) systemRC666-701Public aspects of medicineRA1-1270ENGlobal Heart, Vol 16, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	congenital heart surgery infrastructure surgical capacity Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270
spellingShingle	congenital heart surgery infrastructure surgical capacity Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270 Isaac Wamala Russell Gongwer Kaitlin Doherty-Schmeck Maria Jorina Anne Betzner Bistra Zheleva Kimberlee Gauvreau Christopher W. Baird Kathy Jenkins Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries
description	The care for patients with congenital heart disease (CHD) is multi-disciplinary and resource intensive. There is limited information about the infrastructure available among programs that care for CHD patients in low and middle-income countries (LMIC). A survey covering the entire care-pathway for CHD, from initial assessment to inpatient care and outpatient follow-up, was administered to institutions participating in the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC). Surgical case complexity-mix was collected from the IQIC registry and estimated surgical capacity requirement was based on population data. The statistical association of selected infrastructure with case volume, case-complexity and percentage of estimated case-burden actually treated, was analyzed. Thirty-seven healthcare institutions in seventeen countries with median annual surgical volume of 361 (41–3503) operations completed the survey. There was a median of two (1–16) operating room/s (OR), nine (2–80) intensive care unit (ICU) beds, three (1–20) cardiac surgeons, five (3–30) OR nurses, four (2–35) anesthesiologists, four (1–25) perfusionists, 28 (5–194) ICU nurses, six (0–30) cardiologists and three (1–15) interventional cardiologists. Higher surgical volume was associated with higher OR availability (p = 0.007), number of surgeons (p = 0.002), OR nurses (0.008), anesthesiologists (p = 0.04), perfusionists (p = 0.001), ICU nurses (p < 0.001), years of experience of the most senior surgeon (p = 0.03) or cardiologist (p = 0.05), and ICU bed capacity (p = 0.001). Location in an upper-middle income country (P = 0.04), OR availability (p = 0.02), and number of cardiologists (p = 0.004) were associated with performing a higher percentage of complex cases. This study demonstrates an overall deficit in the infrastructure available for the care of CHD patients among the participating institutions. While there is considerable variation across institutions surveyed, deficits in infrastructure that requires long-term investment like operating rooms, intensive care capacity, and availability of trained staff, are associated with reduced surgical capacity and access to CHD care.
format	article
author	Isaac Wamala Russell Gongwer Kaitlin Doherty-Schmeck Maria Jorina Anne Betzner Bistra Zheleva Kimberlee Gauvreau Christopher W. Baird Kathy Jenkins
author_facet	Isaac Wamala Russell Gongwer Kaitlin Doherty-Schmeck Maria Jorina Anne Betzner Bistra Zheleva Kimberlee Gauvreau Christopher W. Baird Kathy Jenkins
author_sort	Isaac Wamala
title	Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries
title_short	Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries
title_full	Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries
title_fullStr	Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries
title_full_unstemmed	Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries
title_sort	infrastructure availability for the care of congenital heart disease patients and its influence on case volume, complexity and access among healthcare institutions in 17 middle-income countries
publisher	Ubiquity Press
publishDate	2021
url	https://doaj.org/article/914211250ab74d55bd8ad95eb958a4eb
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Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries

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