Congenital Heart DiseaseTrends in Utilization of Specialty Care Centers in California for Adults With Congenital Heart Disease
Section snippets
Methods
We performed a retrospective analysis of hospitalizations for ACHD surgery for discharges of patients 21 to 65 years of age from 2000 and 2011, using unmasked patient discharges, using data from the Office of Statewide Health Planning and Development. This database consists of deidentified demographic, clinical, and administrative data from all acute care hospitals in California. The use of this data set to examine patterns of specialty care hospitalization has been previously described.4, 5
Our
Results
We identified 4,611 discharges that met the inclusion criteria. The discharge characteristics and a comparison of these characteristics between specialty and nonspecialty centers are listed for the entire cohort in Table 2. In-hospital mortality was uncommon for specialty ACHD centers and nonspecialty centers (3.2% and 2.9%, respectively, p = 0.58).
Of the 4,611 discharges, 753 ACHD procedures (16%) were performed in patients with moderate or complex CHD. The discharge characteristics and a
Discussion
Advances in the medical and surgical management of patients with CHD have enabled increased survival to adulthood.9 The ACHD population is aging and becoming increasingly complex, in terms of CHD diagnoses and medical co-morbidities.10, 11 Many of these patients remain at risk for morbidity and mortality because of their underlying CHD and will require repeat intervention in adulthood.12 This study describes trends in ACHD surgery from 2000 to 2011 in California and identifies characteristics
Acknowledgment
The authors would like to acknowledge Jonathan Mayo, MPH, Kirstie MacMillen, BS, CCRC, Miranda Zinsman, BA, and Doff McElhinney, MD, for their time and efforts in this project.
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Cited by (16)
The Long and Winding Road to Adults With Congenital Heart Disease Clinic: Examining Adult Congenital Clinic Nonattendance
2023, American Journal of CardiologyLaparoscopic Surgery Requiring Abdominal Insufflation in Patients With Congenital Heart Disease
2022, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The high-volume centers were significantly more likely to have operated on patients with single-ventricle circulation than the low-volume centers. Recent evidence suggests benefits in regionalization of care for patients with CHD1,23; indeed, one recent study from California reported an increase from 46%-to-71% of patients receiving care at dedicated ACHD centers between 2000 and 2011.24 The regionalization of care, in combination with sampling strategy of the HCUP-NIS database, may have affected the temporal trends observed in this study.
Trends in Patient Characteristic, Cost, and Mortality Among Mechanically Ventilated Adult Patients With Congenital Heart Disease in the United States
2022, CJC OpenCitation Excerpt :This has been attributed to the improved management of mechanically ventilated patients through increased knowledge of ventilator settings18,19 and the incorporation of weaning protocols.20,21 Other potential contributors include better long-term outcomes from enhanced medical and surgical approaches as well as clinicians’ increased comfort and familiarity in managing ACHD, particularly at established centres of excellence.22 Within the limitations of this study’s methodology, the cost per ACHD requiring MV remained stable over the 10-year span (P = 0.42).
Access to cardiac surgery centers for cardiac and non-cardiac hospitalizations in adolescents and adults with congenital heart defects- a descriptive case series study
2021, American Heart JournalCitation Excerpt :Lapses in care have been linked to a number of adverse outcomes, including an increase in concomitant morbidities, a reduction in reported quality of life, and greater mortality.14 Previous studies have suggested that proximity to care may be barrier to care, potentially resulting in such lapses.15,16 The impact of patient residential location, a key factor determining adequate access to care17,18 on healthcare utilization,19-22 has not been investigated extensively among people with CHDs.
Access and Delivery of Adult Congenital Heart Disease Care in the United States: Quality-Driven Team-Based Care
2020, Cardiology ClinicsCitation Excerpt :Even without a formal recognition of CV subspecialty expertise in ACHD, the concept of regional centers began to develop organically after the 2000 Bethesda Conference.26 In 2010, there were approximately 100 US ACHD centers; however, these centers were self-described centers of excellence.27 The centers represented a broad spectrum of expertise, resources, and clinical volume, making the ability to demonstrate that these types of specialized centers improved patient outcomes.
Epidemiology of ACHD: What Has Changed and What is Changing?
2018, Progress in Cardiovascular DiseasesCitation Excerpt :The early data was based on extrapolation of pediatric data into adulthood, with assumptions made about the likelihood of survival based on the severity of the underlying defect.10,32 More recent data has focused on increased hospitalizations and resource utilization of the ACHD population over time.33,34 While there remain significant limitations of these approaches, these endeavors play an important role in drawing attention to the size of the ACHD population and in demonstrating the need for more resources to serve this group.
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