title: The Impact of a Designated Cardiology Team Involving Telemedicine Home Monitoring on the Care of Children with Single-Ventricle Physiology After Norwood Palliation.
abstract: We evaluated the effect of an interdisciplinary single-ventricle task force (SVTF) that utilizes a family-driven, telemedicine home monitoring program on clinical outcomes of stage II admissions and its acceptance by parents and cardiologists. Study population was divided into two cohorts, one with Norwood surgery dates before the SVTF (pre-SVTF) and one interventional (post-SVTF). Post-SVTF data also included surveys of parents and cardiologists on the efficacy of the SVTF. Comparative and multivariate statistical testing was performed. Compared to the pre-SVTF group, the post-SVTF group had lower complications after stage II (18.4 vs. 34.1 %, p = 0.02), higher weight-for-age z scores at stage II (-1.5 ± 0.97 vs. -1.58 ± 1.34, p = 0.02) and were less likely to have a stage II weight-for-age z score below -2 (26.5 vs. 31.7 %, p = 0.03). A multivariate regression analysis showed providing a written red-flag action plan to parents at discharge was independently associated with higher weight at stage II (β = 0.42, p = 0.04) and higher weight-for-age z score (β = 0.48, p = 0.02). Parents' satisfaction with SVTF (α = 0.97) was 4.34 ± 0.62; (95 % CI 4.01-4.67) and cardiologists' acceptance (α = 0.93) was 4.1 ± 0.7 (95 % CI 3.79-4.42). Development of SVTF was associated with a reduction in complications post-stage II and improved weight status at stage II. A written red-flag action plan provided to parents at the time of Norwood discharge was associated with higher weight status at stage II. Parents and cardiologists expressed satisfaction with the utility of SVTF and encouraged expansion to cover all children with congenital heart disease.
authors.affiliation: Children's National Health System, 111 Michigan Ave, N.W., Washington, DC, 20010, USA. AHarahsh@childrensnational.org.|Department of Pediatrics, Division of Cardiology, Children's National Health System, The George Washington University School of Medicine, 111 Michigan Ave, N.W., Washington, DC, 20010, USA. AHarahsh@childrensnational.org.
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Harahsheh
authors.affiliation: Children's National Health System, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Hom
authors.affiliation: Children's National Health System, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.|Department of Pediatrics, Division of Cardiology, Children's National Health System, The George Washington University School of Medicine, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Clauss
authors.affiliation: Children's National Health System, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.|Department of Pediatrics, Division of Cardiology, Children's National Health System, The George Washington University School of Medicine, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Cross
authors.affiliation: Children's National Health System, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Curtis
authors.affiliation: Children's National Health System, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.
authors.forename: Rachel D
authors.initials: RD
authors.lastname: Steury
authors.affiliation: Children's Research Institute, Children's National Health System, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Mitchell
authors.affiliation: Children's National Health System, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.|Department of Pediatrics, Division of Cardiology, Children's National Health System, The George Washington University School of Medicine, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.
authors.forename: Gerard R
authors.initials: GR
authors.lastname: Martin
mesh_terms: D002648:Child; D006352:Heart Ventricles; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome; D007223:Infant; D058327:Norwood Procedures; D010166:Palliative Care; D012189:Retrospective Studies; D012307:Risk Factors; D017216:Telemedicine; D016896:Treatment Outcome
keywords: Family-centered care; Hypoplastic left heart syndrome; Interstage; Quality improvement; Stage I palliation