O1013: National Quality Improvement Learning Collaborative on Optimization of Care for Children with Congenital Heart Defects

Purpose/Objectives: The American Academy of Pediatrics facilitated a Quality Improvement (QI) Learning Collaborative Project, Optimization of Pediatric Medical Home for Children with Congenital Heart Disease, supported through a cooperative agreement with the Centers for Disease Control and Prevention (CDC). The aim of this project was to increase the integration between primary care and specialty pediatricians to improve cardiac and non-cardiac health outcomes for children (5-18 years) with congenital heart defects (CHD) in the context of the pediatric medical home.

Design/Methods: During the course of the 7-month project (December 2021 – July 2022), 7 participating teams attended monthly didactic webinars & coaching calls, completed monthly progress reports based on the Plan-Do-Study-Act model and submitted pre- and post-project assessment surveys. For data collection, practice teams maintained a de-identified registry of all their patients with CHD and collected information on measures such as severity of diagnosis, family goals, communication with cardiac care team, nutritional needs, as well as other details related to their treatment care plan. From the 5 participating teams who submitted all the data, 94 patients with CHD between the ages of 5-18 years old were included in the registries. Information was collected at three data points: baseline, midpoint, and at the project end.

Results: An essential outcome of this collaborative was an improvement in the presence of a pediatric medical home care plan that included cardiac-specific recommendations. By the end of the project there was a 45% improvement in cardiac-specific considerations in care plans and a 20% improvement in the number of cardiac plans of care updated. Surprising gains were also made in the percentage of patients with a physical activity assessment as well as those with a psychosocial/behavioral assessment, resulting in a 30% improvement in patients who had a physical activity assessment, and a 55% improvement in patients who had a documented psychosocial/behavior screening. Teams also reported changing how they talk with and include family feedback to establish goals around physical activity and nutrition that were more aligned with what was essential to the overall family needs, and documented an 18% improvement in the patients who had goals established.

Conclusion/Discussion: This quality improvement collaborative was a highly effective effort focused on the pediatrician role in managing CHD. This project is the first AAP effort to utilize quality improvement to improve pediatric medical home collaboration with a cardiology care team. Quality improvement work identifies high-impact change ideas that can be spread to pediatric offices. Medical home cardiac plans of care should include the family experience and goals to improve the long-term management of patients with CHD.