The Impact of a Designated Cardiology Team Involving Telemedicine Home Monitoring on the Care of Children with Single-Ventricle Physiology After Norwood Palliation
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We evaluated the effect of an interdisciplinary single-ventricle task force (SVTF) that utilizes a family-driven, telemedicine home monitoring program on clinical outcomes of stage II admissions and its acceptance by parents and cardiologists. Study population was divided into two cohorts, one with Norwood surgery dates before the SVTF (pre-SVTF) and one interventional (post-SVTF). Post-SVTF data also included surveys of parents and cardiologists on the efficacy of the SVTF. Comparative and multivariate statistical testing was performed. Compared to the pre-SVTF group, the post-SVTF group had lower complications after stage II (18.4 vs. 34.1 %, p = 0.02), higher weight-for-age z scores at stage II (−1.5 ± 0.97 vs. −1.58 ± 1.34, p = 0.02) and were less likely to have a stage II weight-for-age z score below −2 (26.5 vs. 31.7 %, p = 0.03). A multivariate regression analysis showed providing a written red-flag action plan to parents at discharge was independently associated with higher weight at stage II (β = 0.42, p = 0.04) and higher weight-for-age z score (β = 0.48, p = 0.02). Parents’ satisfaction with SVTF (α = 0.97) was 4.34 ± 0.62; (95 % CI 4.01–4.67) and cardiologists’ acceptance (α = 0.93) was 4.1 ± 0.7 (95 % CI 3.79–4.42). Development of SVTF was associated with a reduction in complications post-stage II and improved weight status at stage II. A written red-flag action plan provided to parents at the time of Norwood discharge was associated with higher weight status at stage II. Parents and cardiologists expressed satisfaction with the utility of SVTF and encouraged expansion to cover all children with congenital heart disease.
KeywordsHypoplastic left heart syndrome Family-centered care Quality improvement Stage I palliation Interstage
The authors wish to thank Angela Doty, Cathleen Shannon and Lindsay Attaway for their editorial assistance; Marcin Gierdalski, Cary McMahon, Lisa Ring and Carla Rothgery for data gathering; Heather Langlois for locating parents’ addresses.
This project was funded in part by C. Richard Beyda Distinguished Professorship in Cardiology, Children’s National Heart Institute/Children’s National Health System, Washington, D.C. Current funding sources for National Pediatric Cardiology Quality Improvement Collaborative include (1) participation fees from enrolled centers; (2) a Grant from the Children’s Heart Association of Cincinnati; (3) a federal Grant to the pediatric Center for Education and Research in Therapeutics at Cincinnati Children’s Hospital Medical Center, funded by the federal Agency for Healthcare Research and Quality [#U19HS021114 AHRQ].
Ashraf Harahsheh was involved in study design, development of surveys, data gathering, analysis of data, and drafting the manuscript. Lisa A. Hom was involved in study design, development of surveys, data gathering, analysis of data, and revising the manuscript. Sarah B. Clauss was involved in data gathering, analysis of data, and revising the manuscript. Amy R. Curtis was involved in development of surveys, data gathering, analysis of data, and revising the manuscript. Russell R. Cross was involved in study design, development of surveys, data gathering, analysis of data, and revising the manuscript. Rachel D. Steury was involved in study design, development of surveys and data gathering. Stephanie J. Mitchell was involved in the analysis of data and revising the manuscript. Gerard R. Martin provided critical revision of the manuscript for important intellectual content. This submission is with the full knowledge and approval of the listed coauthors.
Compliance with Ethical Standards
Conflicts of interest
The authors report no conflicts of interest.
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