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

布雷特·R·安德森，医学博士，MBA，硕士，POR，儿科儿科助理教授 哥伦比亚大学医学中心的心脏病学。她的长期目标是提高产品的质量和价值 为患有先天性心脏病的儿童提供的护理。先天性心脏病是最常见的新生儿 在美国管理的缺陷，并具有较高的相关发病率、死亡率和资源利用率 (1-3)。不同中心之间和不同外科医生之间的结果和资源利用有显著差异。 (3-4)。这种变异的来源未知(4)。在为该奖项提出的研究中，安德森博士 是否会将外科医生的技术技能作为先天性心脏病儿童临床结果的一个可能驱动因素 然后考察制度特征对疾病的影响，控制后的影响 外科医生。拟议研究的主要目的是1)确定外科医生在多大程度上 技术技能预测接受三种高度复杂的先天性心脏手术的婴儿的结果，以及 2)在对技术技能进行控制后，确定与患者结果相关的机构特征 以及外科医生技能和制度因素之间的相互作用。这将是 通过创新的方法实现，将手术的直接视频观察的同行评级联系起来 从国家临床登记和提供者和中心获得外科医生特定患者结果的技能 外科医生问卷中的特征。在建议的为期3年的以患者为导向的指导期间 研究职业发展奖(K23)，安德森博士的知识和技能将通过 实施多学科职业发展计划和跨学科指导 导师和顾问团队。安德森博士的职业发展计划将重点放在以下四个关键 单元：计量经济学和结果研究、质量评估和质量改进、利用 大数据和数据联动，研究传播和职业发展。技能和知识 获得的结果将立即有助于提高先天性心脏病手术的质量，因为 外科医生学习他们的表现与他们的同龄人相比如何，并影响他们的结果 患者，2)帮助确定质量改进的未来目标，以及3)帮助安德森医生成长为 独立调查员，专注于先天性心脏病儿童的质量和价值研究， 能够利用多个大型数据集的比较优势，并能够研究和 实施质量改进计划。

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.