A Milestone for the Ages

Posted Monday, Sep 18, 2023

By Curt Daniels, MD

With 50 ACHD Programs meeting criteria as ACHA ACHD Accredited Comprehensive Care Centers, we've reached a tremendous milestone in the care of patients with adult congenital heart disease (ACHD) in the United States. The road and the process to get to this point had been forged and paved brick by brick, by many over several decades, and is worth noting.

ACHD visionaries Drs. Joseph Perloff and Jane Somerville in the 1980s and 90s predicted and reported on the importance of ACHD as a specialty and the need to develop ACHD centers of excellence. This was followed by Dr. Gary Webb passionately conceptualizing and supporting the concept of center-specific ACHD care and developing ACHD Centers in Canada. In 2001, the 32nd Bethesda Conference detailed the basic framework for delivery of ACHD care, and in 2009, at the ACHA Vision 2020 Forum, more than 60 ACHD providers came together and determined the need and the foundation for ACHD program development and accreditation in the United States.

ACHA Vision 2020 jumpstarted the accreditation process and by 2012 ACHA formed an Accreditation Steering Committee (Mike Landzberg, MD, Gary Webb, MD, Karen Stout, MD, Arwa Saidi, MD, Alison Meadows, MD, Michael Singh, MD, Sue Jameson, PA-C, Jamil Aboulhosn, MD, Amy Verstappen, Ronen Rozenblum, PhD, Craig Broberg, MD, Joe Kay, MD, Curt Daniels, MD, and Paula Miller), with the goal to develop best practice criteria for accreditation to improve the quality of care for patients with ACHD in the United States, and to provide the framework to build an ACHD program. Once complete and reviewed by patients and families with CHD/ACHD, ACHA Accreditation was endorsed and fully supported by more than 10 major professional and patient organization including the American College of Cardiology and the American Heart Association.

The ACHD landscape at that time, in 2014, was quite different than it is today. There were no ACHD board certified cardiologists, no ACGME ACHD fellowships, and no ACHD accredited programs or a clear path for program development. But with ABIM/ABP approval for ACHD subspecialty certification, and ACGME approval for ACHD fellowship training, the necessary elements and background were set to move forward with ACHD program accreditation.

With accreditation criteria developed, vetted and approved, in 2015 piloting the process of program accreditation was started. By 2017, 15 ACHD programs had completed the process of a detailed application, site visit, and steering committee review and approval as an ACHA Comprehensive Care Center. Programs were able to build an ACHD program under an organized accreditation process and gain dedicated time and effort for ACHD Advanced Practice Providers, RNs, and social workers, and solidify important collaborations across subspecialities.

By 2019, there were 33 Accredited programs, and 43 programs by 2021. Over the years, we have added new steering committee members volunteering to accreditation development and working with programs and colleagues toward accreditation (Michael Earing, MD, Jeremy Nicolarson, MD, Richard Krasuski, MD)—all supported by ACHA and their leadership, Mark Roeder and Danielle Hile.

In 2023, during ACHA’s 25th year, we reached 50 ACHA Accredited Programs. The accredited programs are quite diverse in size and geographic location, in utilizing various combinations of children’s vs adult hospitals settings to provide care, and in their growth and development as a program with some programs newly formed and others established for several decades. Even in this early phase of accreditation, there is data to now show improved patient outcomes being cared for in an accredited program, with more studies in development.

There are a number of initiatives planned over the next several years, including the development of accreditation quality measures and initiatives in order to learn from each, continue to improve care for patients, and to provide support for program development.

 

Curt Daniels, MD, is dedicated to volunteering to improve care for those with congenital heart disease by expanding access and delivery of high quality ACHD care in the United States. He has served as Chair of the ABIM ACHD Subspecialty Board, Chair of the ACHA Medical Advisory Board, President of the International Society for ACHD, and Chair for ACHA Program Accreditation. Dr. Daniels is committed to education and ACHD fellowship training and developed the ACHD Fellowship program at OSU and NCH and trained fellows over the past 20 years.

Dr. Daniels is a Professor of Internal Medicine and Pediatrics in the Division of Cardiology at The Ohio State University and the Division of Pediatric Cardiology at Nationwide Children’s Hospital. Dr Daniels is the Dottie Dohan Shepard Endowed Professor in Cardiovascular Medicine. He is the Director of the Columbus Ohio Adult Congenital Heart Disease Program and is board certified in pediatric cardiology, internal medicine cardiology and adult congenital heart disease.