The Congenital Heart Technical Skill Study: Improving Outcomes for Infants and Children with Congenital Heart Disease

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Brett R. Anderson, MD MBA MS/POR is an Assistant Professor of Pediatrics in the Division of Pediatric Cardiology at Columbia University Medical Center. Her long-term goal is to improve the quality and value of care provided to children with congenital heart disease. Congenital heart defects are the most common birth defects managed in the United States and have high associated morbidity, mortality, and resource utilization (1-3). There is marked variation in outcomes and resource utilization between centers and between surgeons (3-4). The sources of this variation are not known (4). In the research proposed for this award, Dr. Anderson will isolate surgeon technical skill as one possible driver of clinical outcomes for children with congenital heart disease and then examine the effects of institutional characteristics, after controlling for the effects of surgeons. The primary aims of the proposed research are 1) to determine the degree to which surgeon technical skill predicts outcomes for infants undergoing three highly complex congenital heart operations, and 2) to identify institutional characteristics associated with patient outcomes, after controlling for the technical skill of surgeons and the interactions between surgeon technical skill and institutional factors. This will be accomplished through innovative methodology that links peer ratings of direct, video observation of surgical skill to surgeon-specific patient outcomes from a national clinical registry and provider and center characteristics from a surgeon questionnaire. During the proposed 3-year Mentored Patient-Oriented Research Career Development Award (K23), Dr. Anderson’s knowledge and skills will be augmented through the implementation of a multidisciplinary career development plan and the guidance of an interdisciplinary team of mentors and advisors. Dr. Anderson’s career development plan will focus on the following four key modules: econometrics and outcomes research, quality assessment and quality improvement, utilization of large data and data linkage, and research dissemination and career development. The skills and knowledge obtained would 1) contribute immediately to improvements in the quality of congenital heart surgery, as surgeons learn how their performance compares to that of their peers and impacts the outcomes of their patients, 2) help to identify future targets for quality improvement, and 3) help Dr. Anderson to grow into an independent investigator, focused on the study of quality and value for children with congenital heart disease, capable both of leveraging the comparative advantages of multiple large datasets and of studying and implementing quality improvement initiatives.