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Joint programs in pediatric cardiac surgery: an update and descriptive analysis.

OBJECTIVE
Joint programs are an alternative model that may aid in improving congenital cardiac surgery outcomes while avoiding the potential resource and accessibility challenges that could result from regionalization. This study aims to characterize current joint programs, identify factors that are associated with joint program success and failure, and gauge attitudes within the profession regarding joint programs as an alternative.


METHODS
A multiple choice survey with 23 standard questions for all participants and additional 42 additional questions for each participant hospital in a joint program was addressed to pediatric cardiac surgeons in the US. Questions were designed to qualitatively and quantitatively characterize congenital cardiac surgery joint programs.


RESULTS
Of the 34 unique congenital cardiac surgery programs identified in this survey, 14 have participated in a joint program and 50% of those joint programs existed for more than 10 years. Most joint programs (86%) participate or participated in a model where participants are engaged in a "mother-daughter" relationship in both perception and case volume distribution. In 3 out of 4 defunct joint programs, there were case complexity limitations placed on partner institutions, but the now independent partner institutions operate with no limitation on complexity. Most (71%) of participants in a joint program felt that the joint program produced better outcomes than two separate programs; however, among those who participate or have participated in a joint program, only 18% felt that joint programs were the optimal model for delivery of congenital cardiac surgical care.