Outcomes research has demonstrated that the quality of pediatric surgical care varies across centers in the United States. Understanding the key drivers of this variation and ultimately how to improve care are critical questions facing clinicia-scientists in pediatric cardiac critical care and cardiac surgery. This proposal seeks to elucidate the underlying reasons for variation in quality of care after pediatric cardiac surgery while providing the career development candidate with a very rich research training and mentorship experience. The research proposal focuses specifically on perioperative mortality for the 20,000 children and young adults who require surgery for pediatric and congenital heart disease each year. Variation in outcomes between hospitals suggests opportunities to reduce potentially avoidable deaths in this vulnerable population. The proposal's research aims include (1) determining the clinical epidemiology of perioperative mortality and the cause- specific mortality that drives variation in hospital performance; (2) analyzing the system and organizational factors that associate with better outcomes; and (3) determining the specific processes of care that underlie hospital performance. This project, the multidisciplinary mentorship team, and the research environment are ideally suited to address the career goals and educational needs of the candidate, Michael G. Gaies, MD, MPH. Dr. Gaies is a board-certified pediatric cardiologist with clinical and scientific interests in patient-centered outcomes research in the pediatric cardiac intensive care unit setting. His prior research experience in studying pediatric cardiac surgical outcomes and interventions to optimize cardiac critical care has prepared him for this proposal. However, he will need additional training to achieve his career goal of improving perioperative care via an international quality-improvement consortium. His educational goals to develop expertise in advanced statistical methods for comparing hospital performance and implementation science are feasible as described in the grant's educational plan with the assistance of his highly accomplished mentorship team. The educational program includes graduate-level coursework, structured seminars, project-based learning, and interaction with international experts in measuring the quality of surgical care. In summary, this research proposal, mentorship team, educational plan, and the overall institutional environment will lay the groundwork for Dr. Gaies to become an innovative, independent scientist capable of translating his findings into improved care for children with critical cardiovascular disease.

Public Health Relevance

This project is designed to improve our understanding of why mortality rates for children having cardiac surgery differ between hospitals. Within a consortium of hospitals from the U.S. and Canada, we will explore the characteristics of high-performing hospitals, and determine the specific clinical practices associated with better hospital performance. These results can be translated into quality improvement initiatives aimed to improve care for all children who require heart surgery.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Clinical Investigator Award (CIA) (K08)
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Special Emphasis Panel (ZHL1-CSR-K (F2))
Program Officer
Huang, Li-Shin
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Gaies, Michael; Ghanayem, Nancy S; Alten, Jeffrey A et al. (2018) Variation in Adjusted Mortality for Medical Admissions to Pediatric Cardiac ICUs. Pediatr Crit Care Med :
Smith, Andrew H; Anand, Vijay; Banerjee, Mousumi et al. (2018) Variation in Case-Mix Adjusted Unplanned Pediatric Cardiac ICU Readmission Rates. Crit Care Med 46:e1175-e1182
Gaies, Michael; Werho, David K; Zhang, Wenying et al. (2018) Duration of Postoperative Mechanical Ventilation as a Quality Metric for Pediatric Cardiac Surgical Programs. Ann Thorac Surg 105:615-621
Brunetti, Marissa A; Gaynor, J William; Retzloff, Lauren B et al. (2018) Characteristics, Risk Factors, and Outcomes of Extracorporeal Membrane Oxygenation Use in Pediatric Cardiac ICUs: A Report From the Pediatric Cardiac Critical Care Consortium Registry. Pediatr Crit Care Med 19:544-552
Tabbutt, Sarah; Schuette, Jennifer; Zhang, Wenying et al. (2018) A Novel Model Demonstrates Variation in Risk-Adjusted Mortality Across Pediatric Cardiac ICUs After Surgery. Pediatr Crit Care Med :
Alten, Jeffrey A; Rahman, A K M Fazlur; Zaccagni, Hayden J et al. (2018) The Epidemiology of Healthcare-associated Infections in Pediatric Cardiac Intensive Care Units. Pediatr Infect Dis J 37:768-772
Alten, Jeffrey A; Klugman, Darren; Raymond, Tia T et al. (2017) Epidemiology and Outcomes of Cardiac Arrest in Pediatric Cardiac ICUs. Pediatr Crit Care Med 18:935-943
Benneyworth, Brian D; Mastropietro, Christopher W; Graham, Eric M et al. (2017) Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals. J Thorac Cardiovasc Surg 153:1519-1526
Romans, Ryan A; Schwartz, Steven M; Costello, John M et al. (2017) Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs. Pediatr Crit Care Med 18:949-957
Gaies, Michael; Pasquali, Sara K; Donohue, Janet E et al. (2016) Seminal Postoperative Complications and Mode of Death After Pediatric Cardiac Surgical Procedures. Ann Thorac Surg 102:628-35

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