A research team from the Ward Family Heart Center at Children’s Mercy Hospital in Kansas City, Missouri has developed the Cardiac High Acuity Monitoring Program (CHAMP) home monitoring model of care to assist families of infants born with hypoplastic left heart syndrome and all forms of single ventricle.
This program will ensure near-instant connection to an enterprise database, provide families with automated analytics, and give graded notifications to the care team.
Infants born with hypoplastic left heart syndrome require staged surgical palliation consisting of 3 surgeries. The periods between surgeries are associated with a high infant mortality rate (between 7% and 19%), which, in 2011, prompted the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) to begin focusing on improving interstage mortality. Many programs have since instituted interstage home monitoring systems.
Beginning in May 2014, researchers used the CHAMP tablet PC as the standard of care for interstage monitoring of infants with single ventricle at the Ward Family Center at Children’s Mercy Hospital.
The goal was to ensure that families received uniform education about the program before discharge, and be provided with a “team,” consisting of a practice registered nurse and a nurse coordinator who would call families on a weekly basis, and whom families could contact in case of any emergent clinical problems.
Researchers also added 2 pediatric cardiologists, a medical director, a social worker, and a dietician to the team and ensured all patients left the hospital with a pulse oximeter and a weight scale.
They followed 30 infants with interstage single ventricle using CHAMP. Fourteen of these infants had hypoplastic left heart syndrome, 12 had right ventricular hypoplasia and pulmonary atresia who underwent an aortopulmonary shunt, and 4 had balanced circulation and were discharged without neonatal surgery.
Clinical outcomes and resource utilization were compared between the period of CHAMP tablet monitoring (April 2014 to present) to the preceding 3 years, when the interstage team and program were being optimized.
When families used the CHAMP tablet, the median age at the end of the interstage period decreased significantly from 7.23 months to 5.83 months (P=.026). Interstage mortality also decreased from 17% to 0% in all patients with single ventricle (P=.025), and from 18% to 0% in patients with hypoplastic left heart syndrome (P-.159).
Adding video to the program has been significant in determining the disposition in >80% of all instant alerts or “red flag events,” as defined by the NPC-QIC.
Overall, the research team collected more than 27 000 data points from 30 patients over 18 months. The hope is that in the future, the CHAMP model of care will provide “dynamic prediction of risk of an adverse event for a given patient at a given time, based on continuously updating and increasing data from the individual patient as well as from the entire cohort.”
“When coupled with a vigilant and responsive team of care-providers, the CHAMP platform enables prompt and targeted clinical care, which may prove to be important as medicine evolves to a value-based model with a focus on outcomes,” researchers concluded.
Shirali G, Erickson L, Apperson J, et al. Harnessing teams and technology to improve outcomes in infants with single ventricle. Circ Cardiovasc Qual Outcomes. 2016. doi: 10.1161/circoutcomes.115.002452.