title: Use of a learning network to improve variation in interstage weight gain after the Norwood operation.
abstract: BACKGROUND
  Growth failure is common in infants with single ventricle. This study evaluated the use of a learning network, the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC), to spread optimized nutritional practices and improve infant growth.
  
  
  METHODS
  A previously identified Nutritional Bundle was spread among NPC-QIC sites.
  
  
  METHODS
  interstage weight-for-age z-score change (ΔWAZ) between discharge from stage 1 palliation (S1) and stage 2 surgical palliation (S2). Variation among sites in interstage ΔWAZ was evaluated before (Period 1) and after (Period 2) spread of Nutritional Bundle. We performed an analysis of NPC-QIC registry infants presenting for S2 at sites previously shown to have significant variation in interstage patient growth.
  
  
  RESULTS
  Four hundred seven infants from 15 sites underwent S2 between 2008 and 2013: 158 in Period 1 (December 2008-December 2010) and 249 in Period 2 (December 2010-April 2013). Median age at S2 was 4.9 months (2.6-12.8) with no difference between periods. There was significant variation in interstage ΔWAZ among sites in Period 1 (P = .01) but not in Period 2 (P = .39). More patients had an interstage ΔWAZ <0 in Period 1 (43%) than Period 2 (32%) (P = .03). In Period 1, the median interstage ΔWAZ was <0 in six sites while in Period 2 no site had median interstage ΔWAZ <0. Sites with the worst patient growth in Period 1 had marked improvement in Period 2 (P = .02, .06, and .06, respectively).
  
  
  CONCLUSIONS
  Spread of optimal nutritional practices led to decreased variation in interstage growth with most improvement observed at sites with the worst baseline growth outcomes.
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; The James M. Anderson Center for Clinical Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Anderson
authors.forename: Robert H
authors.initials: RH
authors.lastname: Beekman
authors.forename: John D
authors.initials: JD
authors.lastname: Kugler
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Rosenthal
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Klitzner
authors.forename: Gerard R
authors.initials: GR
authors.lastname: Martin
authors.forename: Steven R
authors.initials: SR
authors.lastname: Neish
authors.forename: Lynn
authors.initials: L
authors.lastname: Darbie
authors.forename: Eileen
authors.initials: E
authors.lastname: King
authors.forename: Carole
authors.initials: C
authors.lastname: Lannon
mesh_terms: D001903:Bottle Feeding / Q000592:standards*; D001942:Breast Feeding; D003299:Cooperative Behavior; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D041943:Infant Formula / Q000592:standards*; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects / Q000592:standards*; D015596:Nutrition Assessment; D009752:Nutritional Status; D010348:Patient Care Team / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015430:Weight Gain
keywords: Hypoplastic Left Heart Syndrome; Nutrition; Quality Improvement; Variation