Abstract
Background: Equal access to care for patients with congenital heart disease (CHD) remains unrealized globally. The ASSIST project (Academic Medical Hospitals-Local Institutions collaboration) is an ongoing national quality initiative implemented in low-resource settings in China attempting to reduce gaps in access to CHD care. This study sought to evaluate its feasibility and effectiveness.
Methods: Shanghai Children's Medical Center, an academic medical center, has partnered with 4 local hospitals in low-resource regions to enhance local CHD programs since 2021. Comparison was made between patients receiving treatments in these 4 local hospitals before (2013-2020) versus after the ASSIST project (2021-2024). In addition, contemporaneous patients receiving treatments in Shanghai Children's Medical Center (2021-2024) were compared with the post-ASSIST cohort of patients. The primary outcome was a composite of postoperative mortality and multiorgan dysfunction. A key secondary outcome was delayed treatment, defined as an interval of more than 6 months between the time of surgery and the time when the clinicians recommended surgery at the initial presentation.
Results: The analysis cohort included 11 895 pediatric patients (median age, 2.0 years [25th-75th percentile 0.7-5.0]; 5933 female [49.9%]), with 3333 cases in the pre-ASSIST group, 1566 in the post-ASSIST group, and 6996 in the Shanghai Children's Medical Center group. Lower family educational attainment (odds ratio, 1.50 [95% CI 1.21-1.85]; P<0.001) and lower annual household income (odds ratio, 1.65 [95% CI, 1.14-2.38]; P=0.008) were associated with increased incidence of the primary outcome in the low-resource regions but could be mitigated by the ASSIST project in a multivariable model. There was a change in case mix of the CHDs after the ASSIST project, with a significant increase in more complex cases (35.5% versus 7.3%; P<0.001) and neonatal surgery (9.1% versus 1.5%; P<0.001). A higher portion of patients in the pre-ASSIST group had delayed treatment compared with those in the post-ASSIST group (43.2% versus 23.3%; P<0.001). Primary outcome analyses showed that patients in the post-ASSIST group and the Shanghai Children's Medical Center group had equivalent outcomes (4.4% versus 3.6%; P=0.13).
Conclusions: Interhospital partnership appears to be a useful and feasible method to deliver regionalized quality care for pediatric patients with CHD in resource-limited regions.