JCCHD Meeting Minutes
September 12, 2005
Attendees:
Dr. Thomas Klitzner, AAP;
Dr. John Kugler, guest;
Dr. Constantine Mavroudis, CHSS and STS;
Dr. Jack Colman, ISACCD;
Dr. Steve Daniels, AHA;
Dr. Thomas Kulik, ABP,
Dr. Gerard Martin, ACC
Lynn Colegrove, AAP
Welcome/Call to Order:
The meeting was called to order by Dr Thomas Klitzner at 9:30 am on Monday,
September 12, 2005 at the Hotel Sofitel in Rosemont, Illinois. Dr. Klitzner welcomed
those present. The minutes of the September 2004 JCCHD meeting were reviewed and
approved without corrections.
Lines of Succession:
1. Dr. Thomas Kulik, American Board of Pediatrics (ABP): Currently Subboard
Chair
2. Dr. Jack Coleman, International Society of Adult Congenital Cardiac Disease
(ISACCD): Elected as Chair-Elect for two years; will become Chair in one
year.
3. Dr. Constantine Mavroudis, represents both the Congential Heart Surgeons
Society (CHSS) and the Society of Thoracic Surgeons (STS). Dr. Mavroudis
will be President of CHSS until November 2006.
4. Dr. Thomas Klitzner, American Academy of Pediatrics (AAP): Will be
Chairman of the AAP, Section of Cardiology and Cardiac Surgery until
November 2006.
5. Dr. Gerard Martin, American College of Cardiology (ACC): His four-year
term began in March 2005.
6. Dr. Steve Daniels, American Heart Association / Cardiovascular Disease in
the Young (AHA/CVDY): His term expires March 2006. Dr. Catherine
Webb is currently Chair-Elect. She’s currently the sub-chair for two years,
then chair for two years.
Updates:
The representatives from the participating organizations provided updates of projects and
initiatives.
 Dr. Klitzner presented the AAP section update.
o The section is emphasizing promotion of residents and fellows activities in the
following ways:
1. Obtained funding for the Research Fellowship Award for 10-year
commitment to support one $35,000 fellowship per year.
2. Supported 4 Education Travel Grants that fund the travel for a pediatric
cardiologist in-training to the AAP’s National Conference and Exhibition.
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September 12, 2005
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3. Supported 4 Young Investigator Awards that are given to the top 4
abstracts presenters at the Section’s educational /scientific program at
AAP’s annual meeting.
4. The Section has supported the activities of the Pediatric Cardiology
Training Program Directors Society, SPCTPD, (currently headed by Alan
Lewis) and a planning meeting takes place at the AAP’s annual meeting.
o The section has developed the following guidelines:
1.
Co-authored (with the ACC and AHA), the Pediatric Cardiology
Training Statement. This statement will be co-published in Pediatrics in
December ’05.
2.
Authored Cardiovascular Supervision of Patients Affected With
Duchenne and Becker Muscular Dystrophy, to be published in
Pediatrics in December ‘05
3.
Co-authoring Section on Emergency Medicine on a statement of the use
of AED’s in children
o The section has recently developed a directory of all pediatric cardiology
training programs. They are currently developing a directory of cardiologists
and congenital heart disease surgeons in North America. Development of an
electronic version is planned for 2006.
Dr. Daniels presented the CVDY / AHA update:
o Current interest in the education of the general public and the health care
personnel who care for children. Focus is on obesity in general and childhood
obesity in particular. They have entered in a partnership with the Clinton
Foundation in this area.
o Attempts to partner with AAP has resulted in the first successful product:
Dietary Guidelines for Children published in Circulation and Pediatrics
o A working group on screening athletes for CVD has been formed.
o A group has been formed to evaluate and make recommendations on ADHD
and other psych medications regarding CVD.
o Recent papers include:
 Metabolic Syndrome in childhood
 SBE prophylaxis
 Lipid lowering
Recently published:
 Kawasaki Disease
 Childhood obesity
Dr. Colman presented the ISACCD update.
o ISACCD has a worldwide membership with just over 200 members.
o Has a formal affiliation with adult congential heart disease society, and have
jointly published a paper.
o Developing a database for management of adults with CHD with a self
reporting mechanism
o Also working on what to do with adults with CHD and who should care of
these patients.
Dr. Mavroudis presented the CHSS and STS updates.
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o CHSS: Most of the congenital heart surgeons (180-230) belong to this
society. Initially, the society discussed patients. It has since changed into an
organization with an academic database
 New Initiatives:
 Resident education
 Board membership
 “Friends of the Court”
 Established CHSS as the representative group.
o STS:
 Dr. Mavroudis is the chair of the Congenital Heart Surgery Task
Force. The task force oversees the registry database (some data on all
patients), which includes data collection, data verification, reporting,
and publication.
 CHSS has a CHD longitudinal database that contains all of the data on
some of the patients. The STS database has some of the data on all of
the patients. He recommends that the JCCHD does not expand to
include to STS at this time since he represents both. STS position was
to engage the JCCHD meetings at this time since they have a relevant
database.
 Other: Dr. Mavroudis reiterated that JCCHD could fill the void to
speak for the surgeons and cardiologists for North America.
Dr. Kulik presented the ABP update.
o Dual board certification in pediatric cardiology and critical care medicine will
require a 5 year training period, even if the training program is formulated
before sub-specialty training is commenced.
o The Society for Pediatric Electrophysiology voted against pursuing a third tier
certification for pediatric electrophysiology
o The August 2006 pediatric cardiology exam will be, for the first time,
computerized.
o It is anticipated that the internet-based self-assessment program to satisfy Part
2 of the Program for Maintenance of Certification in Pediatrics – will be
offered in the spring of 2007.
o The Part 4 component of the PMCP (national databases, registries, etc.) was
discussed at the October 2004 meeting of the Sub board. Many questions
were asked, and there was a considerable discussion, but no clear avenues of
investigation were identified, nor was there a consensus that the general
notion of such a database is desirable.
Dr. Martin presented the ACC update.
o The inaugural meeting of The Congenital Heart Disease and Pediatric
Cardiology committee was held in Orlando in March’05 to address the
congenital heart disease across all ages. The Committee currently has 550
members. Activities include:
 Improve the tie-in with the planning committee of the Scientific
Sessions and add spotlight sessions for CHD.
 Work on collaborating with the adult group.
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Look at all committees and passports to make sure there is CHD
representation.
Development of an endowment and lectureship.
Development of an expanded web site with links to articles and job
opportunities
 Drs. Martin and Daniels stated that the cardiology research network organized by
NHLBI, is interested in focusing some attention on research regarding adult CHD.
They have developed guidelines and identified research needs. Dr. Daniels stated
that the AHA is very involved in the transition of patients with CHD from the
pediatrician to the adult physician. Dr. Klitzner stated that adult CHD is a topic in
which JCCHD can play an important part.
JCCHD Operational Issues:
1. Future of JCCHD: This is the fifth annual meeting. Dr. David Sahn was Chair for
the first 2 years. Dr. Klitzner became Chair in March of 2004. As per decision
from the 2004 meeting, the group decided that a two-year term is appropriate,
with the next election to be held during the September 2005 meeting. The group
elected Gerard Martin to serve as the next Chair for JCCHD, who will begin his
tenure in March 2006. The AHA will host the next meeting to be held in
September 2006 in Chicago, and the ISACCD in 2007. The four core groups are
ACC, CVDY/AHA, AAP and ABP. The groups agreed to rotate hosting the
annual meeting, with the host assuming the meeting expenses ($600-$800). Dr.
Daniels asked whether other subspecialty organizations could join the JCCHD
such as the NHLBI. Discussion ensued regarding if another organization were to
ask to join JCCHD. The group agreed that other groups could be invited to join
and/or attend the meeting based upon the agenda and initiatives of the group.
This topic was tabled for further discussion.
2. Leadership: The Chair of this organization will serve for two years, beginning in
March of even years, with the selection of the Chair in the fall of preceding year.
This will allow for the transition between chairs prior to the upcoming fall
meeting. If the chair-elect’s term on the JCCHD expires, then the chair-elect
would be allowed to stay on as the chair of JCCHD for the full term. As decided
in the 2004 meeting, the representatives from STS or CHSS should not be chair,
because they are advisors to this group. Decisions are to be made by consensus,
and the JCCHD committee would not require bylaws.
3. Mission: The current Mission Statement for the JCCHD states that JCCHD
should serve as an umbrella organization, to share information among member
organizations.
 CHSS and STS participate as advisors. The group discussed the possibility
that CHSS and STS participate as ex-officio members.
 Dr. Colman reminded the group that the ISACCD is a small organization and
thought the JCCHD should define the role of adult CHD for bigger issues
such as long-term outcomes and management of adults.
4. Format: The standard format has been to have JCCHD meeting in two parts: the
business meeting would be held in the morning and the afternoon meeting would
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include the liaison organizations with presentation of their updates. Information
and issues is to be disseminated via e-mail.
Quality in Pediatric Subspecialty Care Discussion:
Dr. Kugler opened the morning meeting with the overview of the Program for
Maintenance of Certification in Pediatrics – Subspecialty (PMCP-S) and the QPSC
update. He gave a brief history of the ABP’s Maintenance of Certification process.
Three years ago, the subspecialty advisory committee representing each of the 13
subspecialties met to determine how to meet the requirements of re-certification. All of
the 24 members of the American Board of Medical Specialties endorsed the Maintenance
Of Certification (MOC) process as a way to improve the medical care provided by North
American physicians through evidence-based medicine and quality improvement.
Measured unexplained variation in practice performance is an issue in national debate
about quality in healthcare. The ABP and the AAP joined forces in creating programs for
Part IV MOC that help pediatricians not only assess the quality of their practice
performance but also systematically improve care. The program has been slowly
evolving; some subspecialties have not made much progress, others have developed
databases and/or collaborative learning activities. The gastroenterologists are developing
their program on IBD, which will be used to build the model that all pediatric
subspecialties will use. The charge to Cardiology last year was to select a topic or two in
order to proceed to the next step in the process. The subspecialty advisory committee
members for cardiology included Drs. Jim Berker, Steve Niesch, and John Kugler. Dr.
David Sahn replaced Dr. Berker last year Dr. Kugler was selected as the point person for
cardiology representing the JCCHD.
QPSC grew out of the need to create a program that would allow pediatric subspecialties
to meet the requirements of Part IV of the ABP’s new MOC program. The goal was to
create a program that would improve patient care and outcomes and be of value to
practicing pediatric subspecialists. QPSC was a joint effort of the ABP, AAP, the North
Carolina Center for Children’s Healthcare Improvement (NCCHI), and the University of
North Carolina School of Public Health (UNC SPH). Ongoing discussions have also
occurred with the National Association of Childrens Hospitals and Research Institutes/
Virtual Performance System (NACHRI/VPS). The 3-part QPSC model includes 1) webbased educational modules such as the AAP’s eQIPP model to teach quality improvement
(QI), 2) national shared data via comprehensive databases, and 3) multicenter quality
improvement collaboratives and collaborative research such as the Peds GI (IBD), critical
care, Pulmonary (cystic fibrosis), and neonatal/perinatal. The timeline for
implementation of the QPSC modes has been extended until 2008. Negotiations have
begun with NACHRI.
Dr. Kugler summarized the PMCP-cardiology activities. The JCCHD PMCP-S
subcommittee includes Drs. Klitzner, Kugler and Robert Beekman. The group has had at
least 5 conference calls in 2004-05 with Paul Miles of the ABP, Carol Lannon of the
North Carolina Center for Childrens Health Improvement (NCCHI) and Mary Gorman of
NACHRI-VPS. The subcommittee has discussed QPSC and NACHRI collaboration
including development of a national database or using an existing database such as the
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Virtual PICU (VPICU), which serves as a Virtual Performance System (VPS) for several
registries. Questions arise such as who will pay for this endeavor? Funding possibilities
discussed include NACHRI and/or associated institutions, which may be willing to fund
the project from outside grants.
The PMCP-cardiology/ QPSC activities were also discussed at the ABP Subspecialty
Consortium on August 1-2, 2005 that was attended by 3 representatives of each of the 13
subspecialties. Discussion ensued about how best to help pediatric subspecialists assess
and improve practice performance. Updates were given regarding the ABP Part IV
efforts since the 2003 meeting and the future of PMCP-S. Updates regarding the
EQUIPP educational QI modules were provided. Progress has been made by some
subspecialties (GI, Pulm, etc.) and cardiology will be added later. To satisfy part IV for
cardiology, physicians would have to complete an educational eQIPP module by 2008.
Dr. Klitzner elaborated on the JCCHD VPS/STS Pilot QI Project. He stated that in
August 25-26, Drs. Miles, Klitzner and Kugler were invited by NACHRI intensivists to
attend the NACHRI/ VPS – STS meeting due to Cardiology’s interest in the pilot
NACHRI project. The objective of ABP/JCCHD was to investigate whether they would
join forces with NACHRI/ VPS – STS and partner to use the project for development of
the Cardiology QI project. The meeting highlighted the STS/ European Association of
Cardiothoracic Surgery (EACTS) database and the VPS databases. The EACTS database
includes over 10,000 terms and data from 7 meetings however, there was a need for noncardiac comorbidity nomenclature to aid in adding/assessing non-surgical severity of
illness, complexity, risk and outcome. NACHRI’s 1998 PICU Focus Group sought to
develop a clinical PICU dataset to serve its project. The VPS Database (Milwaukee
Childrens) was formed to create common information space for critical caregivers
covering the complete continuity of care from PICU admission through discharge. The
VPICU Performance System provides quality oversight and clinical insight into analysis
of data (patient demographics, diagnoses, interventions, severity of illness/risk
adjustment) and distributes free data collection software for internal reporting to any site.
Another component of the NACHRI project, the Aristotle Score, was also discussed.
This is a complexity-adjusted method to evaluate surgical results that was developed by
the STS. A shortcoming of this system is that PICU complexity needs to be added to
surgical complexity.
Previously, possible topics for the Cardiology QI initiative included Marfan syndrome
(thought to be too rare), CHD in patients with Down’s syndrome, exercise and
cardiology, genetics, syncope and sudden death syndromes (however, no guidelines
exist), mild CHD, and Kawasaki’s syndrome. The medical management of patients with
single ventricle after Fontan Operation had also been discussed as a possible topic.
Dr. Klitzner summarized a potential project for the JCCHD/VPS/STS Pilot QI that was
developed by the JCCHD/QPSC-C subcommittee: Validation of Pre-op Cardiac
Diagnosis and Condition. This would include considering diagnosis before surgery but
also before interventional catheterization and EP. The condition would include the comorbidity diagnoses. He stated that the project needs to be simple and useful for
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cardiologists, patients, hospitals, surgeons and intensivists. Specifics regarding basic
assumptions and tasks were discussed such as how to apply this model to the relevant
preop diagnosis and comorbidities, which data elements needed to be captured, which
patients should be enrolled and which relevant variables were to be collected and
recorded. These issues will be discussed at a future task force meeting to be arranged in
conjunction with the QPSC. More detailed information will then be disseminated via email to JCCHD members at a later date.
Dr. Klitzner discussed the next steps for the JCCHD. The subcommittee plans to
continue communications with ABP, QPSC group (Miles and Lannon), and NACHRIVPS group (Gorman). The charge to JCCHD is threefold: 1) does JCCHD want to be
involved with the PMCP-S, 2) does the JCCHD want to partner with NACHRI and VPS?
3) And if so, to what extent can the JCCHD lend to the UPS-STS? Much discussion
ensued. As was determined in last year’s JCCHD meeting, any decision would have to
be passed through each of the member organizations. Members will seek the
endorsement of each of their organizations for the project and report back to Dr. Klitzner
and John Kugler.
Adjournment
The meeting was adjourned at 3:30 pm. The next meeting will is scheduled for
September 2006 in Chicago.
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