title: Association of Interstage Home Monitoring With Mortality, Readmissions, and Weight Gain: A Multicenter Study from the National Pediatric Cardiology Quality Improvement Collaborative.
abstract: BACKGROUND
  Daily home monitoring of oxygen saturation and weight has been reported to improve outcomes for patients with single-ventricle heart disease during the period between stage I palliation and stage II palliation. However, these studies have been limited to single institutions and used historical control subjects. Our objective was to determine the association of various interstage home monitoring strategies with outcomes using a multicenter cohort with contemporary control subjects.
  
  
  RESULTS
  We performed a retrospective cohort study using prospectively collected data from the National Pediatric Cardiology Quality Improvement Collaborative from 2008 to 2012. We compared interstage mortality, unscheduled readmissions, and change in weight-for-age Z score for various home monitoring strategies of oxygen saturation (n=494) or weight (n=472), adjusting for sex, syndrome, tricuspid regurgitation, arch obstruction, and shunt type. Overall interstage mortality was 8.1%, and 47% had ≥1 unscheduled readmission. We did not find any associations of home oxygen saturation or weight monitoring with mortality or readmission. Although there was no difference in weight-for-age Z score for daily (0.33±0.12) versus weekly (0.34±0.18, P=0.98) weight monitoring, daily home weight monitoring was superior to no home weight monitoring (-0.15±0.18; P<0.01).
  
  
  CONCLUSIONS
  Home weight monitoring is associated with improved weight gain during the interstage period, but we did not find any benefits in other clinical outcomes for either home oxygen saturation monitoring or home weight monitoring.
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.). osterm@kidsheart.com.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ehrlich
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Eileen
authors.initials: E
authors.lastname: King
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Martha
authors.initials: M
authors.lastname: Clabby
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Sherry
authors.initials: S
authors.lastname: Smith
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Michelle
authors.initials: M
authors.lastname: Glanville
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Anderson
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Lynn
authors.initials: L
authors.lastname: Darbie
authors.affiliation: From Children's Healthcare of Atlanta, GA (M.E.O., A.E., C.J.P., M.E.C., S.S., M.G.); Emory University School of Medicine, Atlanta, GA (M.E.O., C.J.P., M.C.); and Cincinnati Children's Hospital Medical Center, OH (E.K., J.A., L.D., R.H.B.).
authors.forename: Robert H
authors.initials: RH
authors.lastname: Beekman
mesh_terms: D058366:Blalock-Taussig Procedure; D001835:Body Weight; D003490:Cyanosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006701:Home Nursing / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000097:blood / Q000601:surgery; D000860:Hypoxia / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D008297:Male; D058327:Norwood Procedures; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D010313:Partial Pressure; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011182:Postoperative Care; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D010100:Oxygen
keywords: heart defects, congenital; home care services; hypoxia; mortality; patient readmission