There are no really precise and good parameters that could be used to evaluate the quality of care in hospitals, which submit the data to the EACTS Congenital Database or similar databases. The databases don’t contain detailed information about patients’ health. Let’s quickly review possible QoC parameters.
- Intermittent Positive Pressure Ventilation (IPPV) time: Mechanical ventilation is used to ensure that the patient gets the oxygen even when too weak to breathe on her/his own. The better treatment, the sooner the patient is able to manage without the mechanical ventilation. However, some hospitals tend to ventilate patients longer than other hospitals, even if patients are doing good.
- Length of Stay (LOS): The better treatment, the sooner the patient is able to leave the hospital. However, some hospitals tend to keep patients longer regardless to the treatment results.
- Mortality is a very coarse parameter, as it only distinguishes dead and alive cases, but unlike IPPV and LOS, it’s not affected by hospitals’ organization and habits.
Of those three, the mortality is the best available quality of care estimator. Unfortunately, it’s tricky to define it. William Williams writes:
The mortality rate after operation (or any other event) is 100%, and only the timing of death is variable.
There are proposals to define a 30-day mortality or hospital mortality. Williams however states that the mortality rate is still high up to one year after surgery.
Unfortunately, there’s no follow-up data in the database. It’s only the present/absent date of death in the patient data, so there’s not enough information to perform the survival analysis.
So far, the 1-year after surgery mortality seems to be the best choice.