Collective efforts to enhance quality of care and outcomes
Launched in 2008, the International Quality Improvement Collaborative (IQIC) for Congenital Heart Disease provides benchmarking data for congenital heart surgery in the developing world, with the overall goal of guiding quality improvement efforts and reducing mortality for congenital heart disease (CHD).
Today, over 70 hospitals from more than 25 countries are enrolled in the IQIC. Participating hospitals experience a significant decrease in morbidity and mortality rates. Because of its proven success, all Children’s HeartLink partner hospitals are expected to participate in the collaborative.
How it works: benchmarking the data
Developed by representatives from Boston Children’s Hospital and several NGOs (nongovernmental organizations) including Children’s HeartLink, the IQIC leverages collaboration between programs in developed and developing countries to:
Collect information about site-specific clinical outcomes following congenital heart surgery , including:
- in-hospital and 30-day mortality
- surgical site and bloodstream infections
- surgical complications
Determine predictors (both patient and procedural) of hospital-specific outcomes based on the collected information:
- evaluation of outcomes and risk-adjusted mortality rates are used as benchmarks for comparison with other participating sites
Use quality improvement methodology to reduce mortality in the developing world based on 3 key drivers of mortality:
- team-based practice
- reduction of surgical site infections and bacterial sepsis
- safe perioperative practice
Improving the quality of care through continuous education
IQIC partners participate in webinars hosted by a multidisciplinary team from Boston Children’s Hospital.
- The webinars feature instructor-led and participatory learning, providing a collaborative experience that can be adapted for individual sites.
- The modules include an overview of the problem, learning objectives, application and problem-solving through case studies and tools for implementation and evaluation.
- The curriculum also includes advanced nursing content.
Evaluation and reporting
Boston Children’s Hospital conducts annual visits or remote auditing sessions with each participating site, to evaluate a sample of the data entered into the database by the site and verify the data’s accuracy.
Sites that pass the data audit receive an annual benchmarking report that allows them to track individual progress and compare their results to their IQIC partners. These reports can be used to evaluate program performance and drive quality improvement at each site.
Improvements at partner hospitals enrolled in IQIC
IQIC data show that participating institutions realized significantly lower rates of post-surgical infection and mortality since joining the collaborative. [1]
- In 2018, ten of Children’s HeartLink’s partner hospitals were compared to their peers in the IQIC.
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- Surgical site infections at the Children’s HeartLink partner hospitals decreased from 7.6% to 1.6% in 2017.
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- Bacterial sepsis decreased from 20.4% to 2.8%.
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- Other major infections decreased from 22.5% to 4.1%.
- From 2010 to 2017, surgical site infections in postoperative patients decreased from 18.3% to 2.9% at Hospital da Criança e Maternidade in São José do Rio Preto, Brazil. They have continued to maintain their performance.
- In a region with extremely long waiting lists, Nhi Dong 1 in Ho Chi Minh City, Vietnam, increased patient volume five-fold in just 2 years: from 3,308 in 2013 to 15,345 in 2015.
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- It tripled the number of surgeries since the partnership began, from 162 in 2008 to 335 in 2015 and 481 in 2023, while increasing the number of complex cases.
- Institut Jantung Negara in Kuala Lumpur, Malaysia, increased the volume of open-heart surgical cases in infants under one year old, from 94 in 2007 to 278 in 2014, maintaining this performance today.