Partnership Model of Regionalized Care for Congenital Heart Disease in Resource-Limited Settings: Results From the ASSIST Project

Abstract

BACKGROUND: Equal access to care for patients with congenital heart disease (CHD) remains unrealized globally. The ASSIST project (Academic Medical Hospitals–Local Institutions collaboration) is an ongoing national quality initiative implemented in low-resource settings in China attempting to reduce gaps in access to CHD care. This study sought to evaluate its feasibility and effectiveness. METHODS: Shanghai Children’s Medical Center, an academic medical center, has partnered with 4 local hospitals in low-resource regions to enhance local CHD programs since 2021. Comparison was made between patients receiving treatments in these 4 local hospitals before (2013–2020) versus after the ASSIST project (2021–2024). In addition, contemporaneous patients receiving treatments in Shanghai Children’s Medical Center (2021–2024) were compared with the post-ASSIST cohort of patients. The primary outcome was a composite of postoperative mortality and multiorgan dysfunction. A key secondary outcome was delayed treatment, defined as an interval of more than 6 months between the time of surgery and the time when the clinicians recommended surgery at the initial presentation. RESULTS: The analysis cohort included 11 895 pediatric patients (median age, 2.0 years [25th–75th percentile 0.7–5.0]; 5933 female [49.9%]), with 3333 cases in the pre-ASSIST group, 1566 in the post-ASSIST group, and 6996 in the Shanghai Children’s Medical Center group. Lower family educational attainment (odds ratio, 1.50 [95% CI 1.21–1.85]; P <0.001) and lower annual household income (odds ratio, 1.65 [95% CI, 1.14–2.38]; P =0.008) were associated with increased incidence of the primary outcome in the low-resource regions but could be mitigated by the ASSIST project in a multivariable model. There was a change in case mix of the CHDs after the ASSIST project, with a significant increase in more complex cases (35.5% versus 7.3%; P <0.001) and neonatal surgery (9.1% versus 1.5%; P <0.001). A higher portion of patients in the pre-ASSIST group had delayed treatment compared with those in the post-ASSIST group (43.2% versus 23.3%; P <0.001). Primary outcome analyses showed that patients in the post-ASSIST group and the Shanghai Children’s Medical Center group had equivalent outcomes (4.4% versus 3.6%; P =0.13). CONCLUSIONS: Interhospital partnership appears to be a useful and feasible method to deliver regionalized quality care for pediatric patients with CHD in resource-limited regions.