Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-25T21:14:16.519Z Has data issue: false hasContentIssue false
  • English
  • Français

Resource utilisation in paediatric patients with secundum atrial septal defects

Published online by Cambridge University Press:  10 February 2020

Daniel S. Ziebell Open the ORCID record for Daniel S. Ziebell [Opens in a new window] ,
Stephanie Ghaleb ,
Jeffrey Anderson  and
Christopher J. Statile
Daniel S. Ziebell*
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Stephanie Ghaleb
Affiliation:
Cincinnati Children’s Medical Center, The Heart Institute, Cincinnati, OH, USA
Jeffrey Anderson
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA Cincinnati Children’s Medical Center, The Heart Institute, Cincinnati, OH, USA
Christopher J. Statile
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA Cincinnati Children’s Medical Center, The Heart Institute, Cincinnati, OH, USA
*
Author for correspondence: D. Ziebell, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH45229, USA. Tel: +1 262 617 4880; Fax: +1 404 785 9188; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

There is variation in care of secundum atrial septal defects. Defects <3 mm and patent foramen ovale are not clinically significant. Defects >3 mm are often followed clinically and may require closure. Variation in how these lesions are monitored may result in over-utilisation of routine studies and higher than necessary patient charges.

Purpose:

To determine utilisation patterns for patients with secundum atrial septal defects diagnosed within the first year of life and compare to locally developed optimal utilisation standard to assess charge savings.

Methods:

This was a retrospective chart review of patients with secundum atrial septal defects diagnosed within the first year of life. Patients with co-existing cardiac lesions were excluded. Total number of clinic visits, electrocardiograms, and echocardiograms were recorded. Total charge was calculated based on our standard institutional charges. Patients were stratified based on lesion and provider type and then compared to “optimal utilisation” using analysis of variance statistical analysis.

Results:

Ninety-seven patients were included, 40 had patent foramen ovale (or atrial septal defect <3 mm), 43 had atrial septal defects not requiring intervention and 14 had atrial septal defects requiring intervention. There was a statistically significant difference in mean charge above optimal for these lesions of $1033, $2885, and $5722 (p < 0.02), respectively. There was statistically significant variation of charge among types of provider as well. Average charge savings per patient would be $2530 with total charge savings of $242,472 if the optimal utilisation pathway was followed.

Conclusion:

Using optimal utilisation and decreasing variation could save the patient significant unnecessary charges.

Keywords

Atrial septal defectASDoptimal utilisationstandardisation
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 3 , March 2020 , pp. 383 - 387
Copyright
© The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

McMahon, CJ, Feltes, TF, Fraley, JK, et al.Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart 2002; 87: 256–259.CrossRefGoogle ScholarPubMed
Haas, NA, Schirmer, KR. Guidelines for the management of congenital heart diseases in childhood and adolescence. Cardiol Young 2017; 27: S1–S105.Google Scholar
Goetschmann, S, Dibernardo, S, Steinmann, H, Pavlovic, M, Sekarski, N, Pfammatter, JP. Frequency of severe pulmonary hypertension complicating “isolated” atrial septal defect in infancy. Am J Cardiol 2008; 102: 340–342.CrossRefGoogle ScholarPubMed
Hanslik, A, Pospisil, U, Salzer-Muhar, U, Greber-Platzer, S, Male, C. Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. Pediatrics 2006; 118: 1560–1565.CrossRefGoogle ScholarPubMed
Cockerham, JT, Martin, TC, Gutierrez, FR, Hartmann, AF, Goldring, D, Strauss, AW. Spontaneous closure of secundum atrial septal defect in infants and young children. Am J Cardiol 1983; 52: 1267–1271.CrossRefGoogle ScholarPubMed
Ghisla, RP, Hannon, DW, Meyer, RA, Kaplan, S. Spontaneous closure of isolated secundum atrial septal defects in infants: an echocardiographic study. Am Heart J 1985; 109: 1327–1333.CrossRefGoogle Scholar
Radzik, D, Davignon, A, van Doesburg, N, Fournier, A, Marchand, T, Ducharme, G. Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life. J Am Coll Cardiol 1993; 22: 851–853.CrossRefGoogle ScholarPubMed
Azhari, N, Shihata, MS, Al-Fatani, A. Spontaneous closure of atrial septal defects within the oval fossa. Cardiol Young 2004; 14: 148–155.CrossRefGoogle ScholarPubMed
Helgason, H, Jonsdottir, G. Spontaneous closure of atrial septal defects. Pediatr Cardiol 1999; 20: 195–199.CrossRefGoogle ScholarPubMed
Park, M. Pediatric Cardiology for Practitioner. Mosby Elsevier, Philadelphia, 2008.Google Scholar
Ungerleider, R, Meliones, J, McMillan, K, Cooper, D, Jacobs, J. Critical Heart Disease in Infants and Children. Elsevier, Philadelphia, 2019.Google Scholar
Driscoll, D, Allen, HD, Atkins, DL, et al.Guidelines for evaluation and management of common congenital cardiac problems in infants, children, and adolescents. A statement for healthcare professionals from the Committee on Congenital Cardiac Defects of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1994; 90: 2180–2188.CrossRefGoogle Scholar
Williams, MR, Perry, JC. Arrhythmias and conduction disorders associated with atrial septal defects. J Thorac Dis 2018; 10: S2940–S2944.10.21037/jtd.2018.08.27CrossRefGoogle ScholarPubMed
Verghese, GR, Friedman, KG, Rathod, RH, et al.Resource utilization reduction for evaluation of chest pain in pediatrics using a Novel Standardized Clinical Assessment and Management Plan (SCAMP). J Am Heart Assoc 2012; 1: pii: jah3-e000349CrossRefGoogle Scholar