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• W3208107733 abstract "Central MessageParental socioeconomic position influences length of stay after the Norwood procedure and thus may influence quality metrics used to evaluate quality of care.See Article page 1604. Parental socioeconomic position influences length of stay after the Norwood procedure and thus may influence quality metrics used to evaluate quality of care. See Article page 1604. Appropriate quality metrics for congenital cardiac surgery have been keenly debated during the past several years. Recently, a composite metric, including length of stay, was proposed for the Congenital Heart Surgery Database.1Pasquali S.K. Shahian D.M. O'Brien S.M. Jacobs M.L. Gaynor J.W. Roman J.C. et al.Development of a congenital heart surgery composite quality metric: part 1-conceptual framework.Ann Thorac Surg. 2019; 107: 583-589Google Scholar Because length of stay may be influenced by factors that are not related to treatment, including socioeconomic status, the validity of this composite metric may be lessened. Spigel and colleagues2Spigel Z.A. Kalustian A. Zink J. Binsalamah Z.M. Caldarone C.A. Low parental socioeconomic position results in longer post-Norwood length of stay.J Thorac Cardiovasc Surg. 2022; 163: 1604-1611.e1Google Scholar examined how length of stay after a Norwood procedure may be related to parental socioeconomic position (SEP). The authors hypothesized that low SEP leads to longer hospital stays because of the time needed to ensure family and home readiness for interstage outpatient monitoring. The study population included 98 patients at a single center who underwent the Norwood procedure and were discharged alive before second stage palliation. Of these, 91% were children of United States citizens or permanent residents, 55% were covered by private insurance, and the median area deprivation index (ADI), a key component in the study's definition of SEP, was 54. Median length of stay was 37 days. For every 10-percentile increase in ADI, length of stay increased by 4%, controlling for other variables. Other components of SEP, including insurance type, immigration status, and distance traveled were not found to influence length of stay. The authors concluded that a significant relationship exists between SEP and length of stay. Data collection was performed via chart review; immigration and insurance status as well as the patient's home address, and thus ADI, were obtained from care coordination notes. These variables served as crude estimates or surrogates for socioeconomic position. The authors could have strengthened their study by reviewing the same notes or social work documentation for evidence that a patient's hospital stay was indeed prolonged because of a family's inadequate resources. This would have been a more direct way of evaluating their hypothesis. This study exclusively examined data for patients with hypoplastic left heart syndrome status after Norwood. This choice is rational when studying length of stay, considering the emphasis on interstage monitoring of discharged patients. Patients not discharged before second-stage palliation were necessarily not included in the analysis. It would be important to know whether or not any of these patients were not discharged strictly because of socioeconomic issues. Again, this insight might have been gleaned from review of the social work notes. Additionally, because of the narrow patient population included here, the question remains whether or not a relationship exists between SEP and length of stay in other groups. We suspect that most physicians have cared for patients for whom coordinating a safe discharge has been difficult due to socioeconomic barriers. Our challenge now is finding the best way to convert anecdote to evidence. This challenge is pressing—policies instituting quality metrics for congenital heart surgery such as length of stay are being developed at the national level. This study adds some evidence that implementing such policies may unfairly penalize hospitals caring for patients with lower socioeconomic position, and more needs to be done to create a just metric that objectively evaluates quality while separating and controlling for other nontreatment-related factors. Low parental socioeconomic position results in longer post-Norwood length of stayThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 5PreviewLength of stay (LOS) has been proposed as a quality metric in congenital heart surgery, but LOS may be influenced by parental socioeconomic position (SEP). We aimed to examine the relationship between post-Norwood LOS and SEP. Full-Text PDF" @default.
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• W3208107733 date "2021-11-01" @default.
• W3208107733 modified "2023-10-17" @default.
• W3208107733 title "Commentary: SEParating Out The Details In Quality Metrics" @default.
• W3208107733 doi "https://doi.org/10.1016/j.jtcvs.2021.10.051" @default.
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