{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T15:54:40Z","timestamp":1768319680486,"version":"3.49.0"},"reference-count":29,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2016,3,29]]},"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Our objective was to characterise the divergence of effort from outcome in congenital heart disease (CHD) care by measuring mortality-related resource utilisation fraction (MRRUF) for various CHD lesions across institutions of differing volumes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Study design was observational analysis of an administrative database, the Pediatric Health Information System (PHIS). The setting was inpatient; 2004\u20132013. Patients were \u226421\u2005years old with atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), hypoplastic left heart syndrome (HLHS) or other single ventricle (SV). There were no interventions but diagnosis, institution (and volume), age, length of hospitalisation, billed charges and deaths were recorded. The main outcome measure was MRRUF, the ratio of investments during hospitalisations ending in fatality to investments during all hospitalisations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 50\u2005939 admissions, 1711 deaths, 703\u2005383 inpatient days, and $10\u2005182\u2005000\u2005000 billed charges. MRRUF varied widely by diagnosis: highest in HLHS (21%), but present in ASD (2%) and VSD (4%). Highest among the very young, MRRUF also increased in HLHS and SV during adolescence. MRRUF increased with hospitalisation duration. MRRUF had no relation to institutional volume, and was static over the decade studied.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Even in the modern era we invest heavily in inpatient CHD care that does not produce the desired outcome. Although its magnitude varies by lesion and age, MRRUF is not limited to complex disease in the very young. MRRUF is not decreasing, and is not isolated to high or low volume institutions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2016-000415","type":"journal-article","created":{"date-parts":[[2016,5,7]],"date-time":"2016-05-07T07:00:53Z","timestamp":1462604453000},"page":"e000415","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Variabilities in the mortality-related resource utilisation for congenital heart disease"],"prefix":"10.1136","volume":"3","author":[{"given":"David A","family":"Danford","sequence":"first","affiliation":[{"name":"University of Nebraska Medical Center College of Medicine, Children's Hospital and Medical Center, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quentin","family":"Karels","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center College of Medicine, Children's Hospital and Medical Center, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelby","family":"Kutty","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center College of Medicine, Children's Hospital and Medical Center, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,5,6]]},"reference":[{"key":"2025081709355161000_3.1.e000415.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2005.02.009"},{"key":"2025081709355161000_3.1.e000415.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.085"},{"key":"2025081709355161000_3.1.e000415.3","doi-asserted-by":"publisher","DOI":"10.1161\/hc3101.093968"},{"key":"2025081709355161000_3.1.e000415.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01272-4"},{"key":"2025081709355161000_3.1.e000415.5","doi-asserted-by":"crossref","first-page":"e106806","DOI":"10.1371\/journal.pone.0106806","article-title":"Modelling survival and mortality risk to 15 years of age for a national cohort of children with serious congenital heart defects diagnosed in infancy","volume":"9","author":"Knowles","year":"2014","journal-title":"PLoS ONE"},{"key":"2025081709355161000_3.1.e000415.6","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s11673-014-9551-2","article-title":"Ethics, rhetoric, and expectations: responsibilities and obligations of health care systems","volume":"11","author":"Foreman","year":"2014","journal-title":"J Bioeth Inq"},{"key":"2025081709355161000_3.1.e000415.7","unstructured":"Cicero K . 10 best children's hospitals. http:\/\/www.parents.com\/health\/doctors\/best-childrens-hospitals (accessed 4 Feb 2013)."},{"key":"2025081709355161000_3.1.e000415.8","unstructured":"Leonard K . 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