{"id":26826,"date":"2024-11-07T04:46:00","date_gmt":"2024-11-06T20:46:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26826"},"modified":"2024-11-07T05:58:02","modified_gmt":"2024-11-06T21:58:02","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%84%bf%e7%a7%91%e5%bf%83%e8%84%8f%e7%9b%91%e6%8a%a4%e5%ae%a4%e4%b8%ad%e5%bf%83%e8%b7%b3%e9%aa%a4%e5%81%9c%e9%a2%84%e9%98%b2%e6%8e%aa","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26826","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u513f\u79d1\u5fc3\u810f\u76d1\u62a4\u5ba4\u4e2d\u5fc3\u8df3\u9aa4\u505c\u9884\u9632\u63aa\u65bd\u7684\u6301\u4e45\u6548\u679c"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Critical Care Medicine<\/p>\n\n\n\n

September 9, 2024<\/p>\n\n\n\n

Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units<\/h1>\n\n\n\n

Dana Mueller, David K. Bailly, Mousumi Banerjee, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2024;7(9):e2432393. doi:10.1001\/jamanetworkopen.2024.32393<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Can 17 hospitals maintain the reduced in-hospital cardiac arrest (IHCA) rate they achieved during the multicenter cardiac arrest prevention (CAP) quality improvement project, and, if so, what factors are associated with sustained improvement?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study of 13\u202f082 CAP era admissions and 16\u202f284 follow-up admissions, there was no difference in risk-adjusted IHCA incidence between the CAP project era and 2-year follow-up era, suggesting sustained improvement. Hospitals with waning engagement in improvement processes had higher odds of IHCA in the follow-up era.<\/p>\n\n\n\n

Meaning<\/strong>  These findings suggest that IHCA prevention improvement is sustainable; consideration of sustainability during the implementation stage and continued engagement in cardiac arrest prevention practices may be associated with maintenance of lower IHCA rate.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  The Pediatric Cardiac Critical Care Consortium (PC4) cardiac arrest prevention (CAP) quality improvement (QI) project facilitated a decreased in-hospital cardiac arrest (IHCA) incidence rate across multiple hospitals. The sustainability of this outcome has not been determined.<\/p>\n\n\n\n

Objective<\/strong>  To examine the IHCA incidence rate at participating hospitals after the QI project ended and discern which factors best aligned with sustained improvement.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This observational cohort study compared IHCA data from the CAP era (July 1, 2018, to December 31, 2019) with data from the 2-year follow-up era (March 1, 2020, to February 28, 2022). Data were obtained from pediatric cardiac intensive care units (CICUs) from 17 PC4 CAP\u2013participating hospitals.<\/p>\n\n\n\n

Intervention<\/strong>  The CAP practice bundle was designed to facilitate local practice integration, with the intention to implement, adapt, and continue CAP processes beyond the CAP era. A web-based survey was administered 2 years after the end of the project to estimate CAP-specific QI work.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Risk-adjusted IHCA incidence rates across all admissions were compared between study eras. The survey generated a novel hospital-specific QI sustainability score, which is generally reflective of the sum of local CAP work performed.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0There were no clinically important differences in demographic and admission characteristics between the 13\u202f082 CAP era admissions and 16\u202f284 follow-up admissions (total mean [SD] age, 5.1 [8.4] years; 56.1% male). Risk-adjusted IHCA incidences were not different between the CAP vs follow-up eras (2.8% vs 2.8%; odds ratio, 1.03; 95% CI, 0.89-1.19), suggesting sustained prevention improvement. There was also no difference between eras in risk-adjusted IHCA incidence within medical, surgical, or high-risk subgroups. A lower hospital QI sustainability score was correlated with higher odds for IHCA in the follow-up vs CAP era (correlation coefficient, \u22120.58;\u00a0P<\/em>\u2009=\u2009.02). Five hospitals had increases of 1% or greater in risk-adjusted IHCA rates in the follow-up era; these hospitals had significantly lower QI sustainability scores and were less likely to have adopted sustainability elements during the CAP era or report persistent engagement for CAP-related QI processes during follow-up.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this cohort study of all CICU admissions across 17 hospitals, IHCA prevention was feasible and sustainable; the established reduction in risk-adjusted IHCA rate was maintained for at least 2 years after the end of the CAP project. Both implementation strategies and continued engagement in CAP processes during the follow-up era were associated with sustained improvement.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Critical Care Medicine Sep […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26826"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26826"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26826\/revisions"}],"predecessor-version":[{"id":27114,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26826\/revisions\/27114"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26826"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26826"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26826"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}