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Background Value-based healthcare (VBHC) is a promising strategy to increase patient value. For a successful implementation of VBHC, intensive collaborations between organizations and integrated care delivery systems are key conditions. Our aim was to evaluate the effects of a pilot study regarding enhancing regional integration between a cardiac centre and a referring hospital on patient-relevant clinical outcomes and patient satisfaction.Methods The study population consisted of a sample of patients treated for coronary artery disease by use of a coronary artery bypass graft or a percutaneous coronary intervention between 2011 and 2016. Since 2013, the two hospitals have implemented different interventions to improve clinical outcomes and the degree of patient satisfaction, e.g. improvement of communication, increased consultant capacity, and introduction of outpatient clinic for complex patients. To identify intervention effects, logistic regression analyses were conducted. Patients’ initial conditions, like demographics and health status, were included in the model as predictors. Clinical data extracted from the electronic health records and the hospitals’ cardiac databases as well as survey-based data were used.Results Our findings indicate a non-significant increase of event-free survival of patients treated between 2014 and 2016 compared to patients treated between 2011 and 2013 (97.4% vs. 96.7% respectively). This non-significant improvement over time has led to significant better outcomes for patients referred from the study referring hospital compared to patients referred from other hospitals. The level of patient satisfaction (response rate 32.2%;216 out of 669) was improved and reached statistically significant higher scores regarding patient information and education (p=.013), quality of care (p=.007), hospital admission and stay (p=.032), personal contact with the physician (p=.024), and total impression (p=.007).Conclusions This study shows a promising effect of regional integration. An intensified collaboration in the care chain, organized in a structured manner between a cardiac centre and a referring hospital and aiming at high quality, resulted in successful improvement of clinical outcomes and degree of patient satisfaction. The applied method may be used as a starting point of regional integration with other referring hospitals. We encourage others to organize the whole care chain to continuously improve patient-relevant outcomes and patient satisfaction.Trial registration: ISRCTN11311830. Registered 01 October 2018 (retrospectively registered)

Objective Veno-Arterial Extra Corporeal Life Support (VA ECLS) is widely used as an effective device for patients in cardiogenic shock. The need for predictive markers that daily guide physicians in the evaluation of these patients could be of great value. Our aim was to investigate the role of cholesterol value during VA ECLS in predicting the Intensive Care Unit (ICU) survival. Methods Between January 2013 and November 2019, 67 patients with VA ECLS due to cardiogenic shock were included in this study. Demographic data, laboratory values, ICU data and outcomes were collected. Cholesterol was measured during morning routine blood samples. The minimal cholesterol value during the ICU stay was registered. Groups were stratified by minimal cholesterol cut-off point of 2.0 mmol/L. Logistic regression analysis were performed to identify variables associated with ICU survival. Results The ECLS duration was not significantly different (p=0.36) between the non-survivors (median 5.0 (2.0-7.5) days) and survivors (median 6.0 (1.8-12.0) days). The minimal cholesterol level was significantly lower (p=0.04) in non-survivors group (1.54 (1.00-1.87) mmol/L) compared to survivors (1.85 (1.38-2.24) mmol/L). By using logistic regression analysis, minimal cholesterol level of ≥2.0 mmol/L was associated with a higher ICU survival (p=0.02; OR 3.77; 95% CI 1.20-11.81). Conclusion Cholesterol level could be an additional marker for ICU survival of patients with cardiogenic shock on VA ECLS. A larger cohort of patients is necessary to determine total cholesterol as a specific risk factor for survival in these patients.

Recently, paediatric cardiac computed tomography (CCT) has caused concerns that diagnostic image quality and dose reduction may require further improvement. Consequently, this study aimed to establish institutional (local) diagnostic reference levels (LDRLs) for CCT for paediatric patients, and assess the impact of tube voltage on proposed DRLs in terms of the volume computed tomography index (CTDIvol) and dose length product (DLP). In addition, effective doses (EDs) of exposure were estimated. A population of 453 infants, whose mass and age were less than 12 kg and 2 years, respectively, were considered from January 2018 to August 2021. Based on previous studies, this number of patients was considered to be sufficient for establishing LDRLs. A group of 245 patients underwent CCT examinations at 70 kVp tube voltage with an average scan range of 23.4 cm. Another set of 208 patients underwent CCT examinations at 100 kVp tube voltage with an average scan range of 15.8 cm. The observed CTDIvol and DLP values were 2.8 mGy and 54.8 mGy.cm, respectively. The mean effective dose (ED) was 1.2 mSv. It is concluded that provisional establishment and use of DRLs for cardiac computed tomography in children are crucial, and further research is needed to develop regional and international DRLs.