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High-Quality Hospitals Deliver Lowest-Cost Care For Congenital Heart Surgery Patients

U.S. children’s hospitals delivering the highest-quality care for children undergoing heart surgery, also appear to provide care most efficiently at a low cost, according to research led by the University of Michigan and presented Tuesday at the American Heart Association Scientific Sessions in Chicago.

Congenital heart defects are the most common birth defects, and each year more than 30,000 congenital heart operations are performed across U.S. children’s hospitals. Congenital heart defects are also one of the most expensive pediatric conditions to treat.

Given the many current initiatives in healthcare aimed at both improving quality of care and reducing costs, or optimizing value, University of Michigan researchers along with collaborators across several different U.S. children’s hospitals decided to study whether it is possible to deliver high-quality heart care but also at a low cost, says the study’s lead author, Sara K. Pasquali, M.D., associate professor of pediatric cardiology within the Michigan Congenital Heart Center at U-M’s C.S. Mott Children’s Hospital and U-M’s Center for Healthcare Outcomes and Policy.

The researchers studied 30,670 patients ages 0-18 years undergoing heart surgery across 27 different hospitals, using a unique dataset of merged clinical and cost information from the Society of Thoracic Surgeons and Children’s Hospital Association.  

According to Pasquali, costs of care differed by 5-fold across these hospitals.  The lowest -cost hospitals had significantly lower mortality rates compared to the other hospitals.  The low-cost hospitals also had shorter lengths of stay after surgery and fewer post-operative complications.

Interestingly, the low-cost hospitals tended to be larger volume centers, who were able to achieve these outcomes despite treating a more high-risk patient population.

“The care of children with congenital heart conditions is complex and requires significant investment of resources.  It has been unclear whether there are centers able to provide high quality care, but also at a low cost,” says Pasquali, who is a member of the Institute for Healthcare Policy and Innovation at U-M.

“Understanding these relationships is critical in the appropriate design of policies aiming to optimize healthcare value in this population and others. For example, one would not want to provide incentives to low-cost hospitals if these low costs were due to poor clinical outcomes, such as high rates of mortality.”

What this new research shows, Pasquali says, is that lower-cost hospitals seem to be doing the right thing: they are delivering the highest-quality care to children undergoing heart surgery.

“In addition, these results suggest that initiatives that aiming to improve quality of care and outcomes, may also hold the potential to reduce costs in this population she says.

Additional authors: Of the University of Michigan: Edward L. Bove, Michael G. Gaies, Jennifer C. Hirsch-Romano. Of Johns Hopkins: Jeffrey P. Jacobs, Marshall L. Jacobs.  Of Children’s Hospital of Philadelphia: J. William Gaynor.  Of Duke Clinical Research Institute:  Eric D. Peterson, Xia He.  Of Boston Children’s Hospital:  John E. Mayer.  Of Primary Children’s Hospital: Nelangi M. Pinto. Of Cincinnati Children’s Hospital Medical Center: Samir S. Shah.  Of Children’s Hospital Association: Matt Hall.

Funding: This study was funded by the National Heart, Lung, and Blood Institute.

Disclosure: None

About congenital heart services at C.S. Mott Children’s Hospital:   The specialists at the Congenital Heart Center at C.S. Mott Children's Hospital are skilled at treating the full spectrum of congenital heart conditions. As one of the highest volume programs in the country, we perform approximately 900 procedures a year.  U.S. News and World Report ranked our program in the top 10 in the country for cardiology and heart surgery. More information is available at

This story was originally published by the University of Michigan Health System on Nov. 19, 2014.