collection and analytics infrastructure which can continuously inform learning in new versions of the guidelines This approach has been applied to diverse pediatric cardiology conditions such as chest pain, syncope, balloon dilation for congenital aortic stenosis, and the postoperative management of the arterial switch operation, demonstrating reductions in resource utilization while maintaining quality of care.67–70 Improving Outcomes Through Networks and Collaboration Given the number of congenital and pediatric cardiac conditions and the small patient population for any given condition at each individual center, the pediatric cardiology and cardiac surgery fields have long recognized the necessity of working together to improve outcomes There are several mechanisms by which multiple centers collaborate to improve outcomes for the field, including: ▪ Informal discussion about variation in care practices and outcomes ▪ Case presentations and discussion at conferences ▪ Sharing outcomes transparently to allow for learning from high performers ▪ Multicenter research to identify best practices in care ▪ Structured, time-limited multicenter collaborative quality improvement projects ▪ Multicenter learning networks that use data for research and improvement The concept of collaborative quality improvement in health care springs from the Northern New England Cardiovascular Disease Study Group (NNECDSG), which developed the first collaborative quality intervention in the early 1990s.71 Many pediatric collaborative improvement efforts have followed the example of NNECDSG since then, ranging from short-term, focused improvement projects such as reducing central line associated blood stream infections to long-term learning networks focused on improving outcomes for specific populations (Table 87.2) Many of these improvement efforts use the Breakthrough Series of the Institute for Healthcare Improvement as an organizing framework (see earlier).72 In pediatric cardiology and cardiac surgery, organizations have taken the learning network approach with the intention of working together for many years We highlight a few collaborative organizations of note in this section Table 87.2 Pediatric Research and Improvement Collaboratives Children's Oncology Group Cystic Fibrosis Foundation Improve Care Now (inflammatory bowel disease) Improving Pediatric Sepsis Outcomes (Children's Hospital Association: Central Line Associated Blood Stream Infection) Pediatric Intensive Care Unit Central Line Associated Blood Stream Infection Collaborative (Children's Hospital Association) Solutions for Patient Safety Vermont Oxford Network (neonatology) These groups within pediatric specialties have used the learning network model to improve clinical outcomes Congenital Heart Surgeons’ Society The Congenital Heart Surgeons’ Society (CHSS; http://chss.org/) was founded in 1973 as a small group of surgeons who met annually to discuss challenges in the new field of congenital heart surgery To build on informal clinical improvements achieved through annual discussions of challenging cases and evolving techniques, in 1985 CHSS established its first multicenter cohort study to evaluate surgical management strategies for transposition of the great arteries Identification of factors that improved outcomes from that first cohort study helped underperforming centers improve outcomes, illustrating that collaborative research could inform local improvements, and ultimately resulting in an improvement in field outcomes The CHSS continues to study multiple diseasespecific cohorts and foster honest discussion about clinical problems and solutions among its membership to further advance the field of congenital heart surgery.73 Northern New England Cardiovascular Disease Study Group As mentioned previously, the NNECDSG began in 1987 as a voluntary research consortium consisting of five hospitals in Maine, New Hampshire, and Vermont After determining that mortality differences across centers could not be due to case mix differences alone, NNECDSG embarked upon its first collaborative learning intervention to reduce mortality after coronary artery bypass graft surgery The intervention included data feedback, training in quality improvement methods, and site visits to other centers After the intervention, NNECDSG reported a 24% reduction in the hospital mortality rate over 2 years.71 Since that first intervention, NNECDSG has continued to work on a variety of clinical problems including reducing rates of postoperative fatal low cardiac output, neurologic injury, kidney injury, and transfusion among others.74 Importantly, NNECDSG continues to serve both as inspiration and as a model for collaboratives within cardiac surgery, pediatrics, and other fields of medicine Pediatric Heart Network In contrast to the grassroots beginnings of CHSS and NNECDSG, the Pediatric Heart Network (PHN; http://www.pediatricheartnetwork.org/) was founded by the National Heart, Lung, and Blood Institute (https://www.nhlbi.nih.gov/) in 2001 to improve public health by performing and disseminating collaborative research to improve outcomes for acquired and congenital heart disease in children.75 The PHN has completed more than 12 multicenter studies on a variety of disease processes, including randomized controlled trials and observational studies Inspired by NNECDSG's original collaborative learning intervention and informed by identification of variation in care processes identified through previous PHN studies, the PHN used collaborative improvement concepts in its Collaborative Learning Study Using round robin site visits, collaborative development of an early extubation CPG, and data feedback, participating sites increased rates of early extubation after surgery for coarctation and tetralogy of Fallot.76 ... for collaboratives within cardiac surgery, pediatrics, and other fields of medicine Pediatric Heart Network In contrast to the grassroots beginnings of CHSS and NNECDSG, the Pediatric Heart Network (PHN; http://www.pediatricheartnetwork.org/) was founded by... We highlight a few collaborative organizations of note in this section Table 87.2 Pediatric Research and Improvement Collaboratives Children's Oncology Group Cystic Fibrosis Foundation Improve Care Now (inflammatory bowel disease) Improving Pediatric Sepsis Outcomes (Children's Hospital Association: Central Line Associated Blood Stream... Many of these improvement efforts use the Breakthrough Series of the Institute for Healthcare Improvement as an organizing framework (see earlier).72 In pediatric cardiology and cardiac surgery, organizations have taken the learning network approach with the intention of working together for many