ACTION Registry GWTG Version 2.4

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ACTION Registry

ACTION Registry –

–

– GWTG

–

GWTG

Version 2.4

Dr. Joanne Foody

Kim Hustler

The following relationships exist:

Dr. Foody:Janssen, Sanofi, Genzyme, Aegerion, Amarin, BristolMeyersSquibb, Abbott, Gilead,

ACC, Pfizer, Merck Kim Hustler: No Disclosures

Session Objectives

• Outline the data points that will be changing for ACTION Registry – GWTG Version 2.4

• Discuss the rationale and implications for the changes in the data elements

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Disclosures

• Dr. Joanne Foody

– No Disclosures to report

• Kim Hustler

– No Disclosures to report

Version 2.4 Update - Why Change?

• New therapies/medications • Research/Clinical Guidelines • Collaborative/Integrated Care • Improved quality of data in registry • Public reporting

– Physician reporting

• Aligning with other NCDR Registries

ARS Question #1

Who Who Who

Who did we include in the process of did we include in the process of did we include in the process of did we include in the process of determining what fields to add determining what fields to adddetermining what fields to add determining what fields to add????

1. Email suggestions 2. RSM calls

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ARS Question #2

How did we determine what fields to remove? How did we determine what fields to remove?How did we determine what fields to remove? How did we determine what fields to remove? 1. Frequency of fields being answered 2. Current practice

3. Core data elements

4. Enough data already captured 5. All of the above

ACTION -GWTG Q.I.

Subcommittee Members

• Dr. Joanne Foody – Chair

• Dr. Karen Alexander • Dr. Donald Casey • Dr. Shahriar Dadkhah • Dr William French • Dr. Michael Ho • Dr. Mauro Moscucci • Dr. Gregg Fonarow • Dr. Judith Lichtman • Dr. Nurcan Illksoy • Dr. James Jollis • Dr. Mikhail Kosiborod

Process

• SQOC – Science & Quality Oversight Committee

• ACTION Registry – GWTG Steering Committee

• Stakeholder feedback • NCDR Management Board •

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Registry Site Manager Calls

• Calls were specifically to obtain feedback from users

• Two Teleconferences

September 27, 2011 October 6, 2011

Be Careful What

You Ask For!

Version 2.4 Changes

New therapies/medications New therapies/medications New therapies/medications New therapies/medications • Medications – Dabigatran – Rivaroxaban

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Section E- Medications

New medication: Xarelto (Rivaroxaban)

Documentation: Documentation:Documentation: Documentation:

• History of Atrial fibrillation • Presents with symptoms of ACS • Positive Troponins- NSTEMI

• Physician discharges patient on Xarelto

ARS Question # 32

How will How will How will

How will you enter you enter you enter the Xarelto in the data you enter the Xarelto in the data the Xarelto in the data the Xarelto in the data collection tool?

collection tool? collection tool? collection tool? 1.Do not include

2.Answer Warfarin at discharge Seq. #6220 as “contraindicated”

3.Answer Warfarin at discharge Seq. #6220 as “yes”

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Version 2.4 Changes – Removed fields

• ASA date/time & dose (1st24 hours) • Ticlopidine date/time & dose (1st24 hours) • Prasugrel dose (1st24 hours)

• Beta blocker date/time

• Duration of P2Y12’s at discharge • Option of blinded

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Version 2.4 Changes

• New field for Statin therapy at discharge

• “Less than Intensive” Statin Therapy • “Intensive” Statin Therapy

Version 2.4 Changes

• Unfractionated Heparin

Version 2.4 Changes

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Version 2.4 Changes

• Anticoagulants removed

Section E- Medications

Excessive dosing UFH- no PCI

• Presents with N/V, left arm pain • 12 lead ECG- STEMI

• To cath lab for primary PCI- 5000 units UFH given in cath lab

• Coronary arteries- clean • No PCI is performed

Excessive dosing UFH- no PCI

The data collection form would be completed as: • Reperfusion Candidate #8000 “yes”

• Primary PCI #8015 “no” Reason no PCI #8030- Anatomy not suitable to primary PCI

• Thrombolytic “no”, reason #8035- Expected DTB <90 min- if was expected

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ARS Question # 4

Would this patient be included in the UFH Would this patient be included in the UFH Would this patient be included in the UFH Would this patient be included in the UFH Excessive dosing report as we are currently Excessive dosing report as we are currently Excessive dosing report as we are currently Excessive dosing report as we are currently entering it entering itentering it entering it???? 1. No 2. Yes

Answer: #1 (No)

• As of October 1, 2013 discharges “Diagnostic Angiography Time” Seq. #7022 is the identifying time for UFH doses administered in the cath lab • If date/time of UFH Seq. #6852/6853 is prior to prior to prior to prior to

Angiography time, it is included

• If afterafterafterafter Angiography time- dose is excluded

Section E- Medications Excessive dosing UFH

Documentation DocumentationDocumentation Documentation::::

• Presents with N/V, left arm pain at 04:00 • 12 lead ECG- negative

• Cardiac Biomarkers elevated- NSTEMI • Weight 100 kg

• ED starts UFH infusion at 1000 U at 05:00 • To cath lab at 08:00

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ARS Question # 5

Would this patient be included in the UFH Would this patient be included in the UFH Would this patient be included in the UFH Would this patient be included in the UFH Excessive dosing report as we are currently Excessive dosing report as we are currently Excessive dosing report as we are currently Excessive dosing report as we are currently entering it

entering itentering it entering it???? 1. No 2. Yes

V2.4 Excessive dose UFH

• V2.4 will capture date/time for both initial doses (bolus & infusion)

• The dates/times provide verification of administration prior to or after arrival in cath lab

• Patient can only ‘fail’ the Excessive Dosing metric once

Version 2.4 Changes

Aligning Registries

• PCI Indications • Arterial access site

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Version 2.3 Procedure fields

Version 2.4 Changes

• Coronary Stenosis % removed

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Version 2.4 Changes

PCI Indications & arterial access site PCI Indications & arterial access sitePCI Indications & arterial access site PCI Indications & arterial access site

Version 2.4 Changes

Hypothermia therapy Hypothermia therapyHypothermia therapy Hypothermia therapy

Section F- Procedures & Tests

PCI Indication V2.4

Documentation:

Documentation:Documentation: Documentation:

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ARS Question # 62

What would you select for PCI Indication? What would you select for PCI Indication? What would you select for PCI Indication? What would you select for PCI Indication?

1. 1. 1.

1. Primary PCI for STEMIPrimary PCI for STEMIPrimary PCI for STEMIPrimary PCI for STEMI 2.

2. 2.

2. PCI for STEMI (unstable, >12 PCI for STEMI (unstable, >12 PCI for STEMI (unstable, >12 hrPCI for STEMI (unstable, >12 hrhrhr from from from sxfrom sxsxsx onset)onset)onset)onset) 3.

3. 3.

3. PCI for STEMI PCI for STEMI PCI for STEMI (stablePCI for STEMI (stable(stable(stable, >12 , >12 , >12 , >12 hrhr from hrhrfrom from sxfrom sxsxsx onsetonsetonsetonset))))

Version 2.4 Additions

Demographics DemographicsDemographics

Demographics---- Race detail linesRace detail linesRace detail linesRace detail lines

Section A- Demographics

Hispanic or Latino Ethnicity

Documentation:

• Presents meeting criteria for NSTEMI • Noted in town visiting family, home Mexico • Her last name is Garcia

• Primary language: English • Secondary language: Spanish

• No documentation of race/ethnicity in medical record

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ARS Question #7

2

How How How

How would you would you would you answer Hispanic or Latino would you answer Hispanic or Latino answer Hispanic or Latino answer Hispanic or Latino Ethnicity Seq. #2076? Ethnicity Seq. #2076? Ethnicity Seq. #2076? Ethnicity Seq. #2076? 1. No 2. Yes 3. Yes, Mexican

Version 2.4 Changes

Research/Clinical Guidelines Research/Clinical GuidelinesResearch/Clinical Guidelines Research/Clinical Guidelines

• Additional In-Hospital Clinical events • Home Functioning/Cognitive Status

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Version 2.4 Changes

Home Functioning Home Functioning Home Functioning Home Functioning

Version 2.4 Changes

• Cocaine use • COPD

• Atrial fib or flutter- “past 2 weeks” “past 2 weeks” “past 2 weeks” “past 2 weeks” removed

Version 2.4 Changes

• Cancer history added

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Version 2.4 Changes

Collaborative/Integrated Care Collaborative/Integrated Care Collaborative/Integrated Care Collaborative/Integrated Care • Two FMC fields to capture non-EMS FMC • Non-system reason for delay for First

Medical Contact

• Additional EMS fields & cath lab activation

Two FMC fields to capture non Two FMC fields to capture non Two FMC fields to capture non

Two FMC fields to capture non----EMS FMCEMS FMCEMS FMCEMS FMC Non

Non Non

Non----system system system system reason for delay for First Medical reason for delay for First Medical reason for delay for First Medical reason for delay for First Medical Contact

ContactContact Contact

Version 2.4 Changes for FMC

Section B- Admission Means of Transport to First Facility

• EMS called to home of female with symptoms of ACS • BLS unit dispatched, ALS unit arrived 5 minutes later

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ARS Question # 8

What would you enter for Means of What would you enter for Means of What would you enter for Means of What would you enter for Means of Transport to First Facility?

Transport to First Facility? Transport to First Facility? Transport to First Facility? 1. Self/Family

2. Ambulance 3. Mobile ICU

Section B- Admission

First Medical Contact time Seq. #3106

Documentation: Documentation: Documentation: Documentation:

• Presented to physician office at 11:30 with 2 hours of epigastric pain, and pain radiating down left arm • ECG- STEMI

• EMS patient contact time 11:50- transported by ambulance to PCI hospital

• Immediate Primary PCI

ARS Question # 9

What time would you enter in for First What time would you enter in for First What time would you enter in for First What time would you enter in for First Medical Contact time Seq. #3106? Medical Contact time Seq. #3106? Medical Contact time Seq. #3106? Medical Contact time Seq. #3106? 1. 11:30 Physician Office contact time 2. 11:50 EMS contact time

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Data Collection Form Starting with January 1, 2014 discharges Enter into Auxiliary field 4 the response to question:

Was EMS the first medical contact?

Data Collection Tool

Enter “Y” or “N” into Auxiliary field 4 under Discharge Note- answer “N” when no first medical contact

Additional EMS fields & Additional EMS fields & Additional EMS fields &

Additional EMS fields & cathcathcathcath lab activationlab activationlab activationlab activation

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Version 2.4 Changes

Improved quality of data in registry

• Non-system reason for delay for ECG’s

• Geographic concerns with D2B patients

• Initial and peak lab values

Version 2.4 Changes

Non NonNon

Non----system system system system reason for delay for ECG’sreason for delay for ECG’sreason for delay for ECG’sreason for delay for ECG’s

V2.4 Changes

Door to ECG Quality Metric #22

Documentation: Documentation: Documentation: Documentation:

• EMS arrives at scene patient in cardiac arrest • Code ran 11 minutes- Defib, CPR,

meds-resuscitated

• Transported to hospital- presented in cardiac arrest at 11:05

• Coded for 10 minutes-resuscitated • ECG- at 11:20- STEMI

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ARS Question # 10

How is the ECG captured currently? How is the ECG captured currently? How is the ECG captured currently? How is the ECG captured currently? 1. 1st_{ECG in metric denominator/”no”}

numerator

2. Subsequent ECG- excluded

3. Excluded for non-system reason for delay

Version 2.4 Changes

Geographic concerns with D Geographic concerns with DGeographic concerns with D

Geographic concerns with D2222B patientsB patientsB patientsB patients

Version 2.4 Changes

Initial

Initial & peak or lowest lab values same

& peak or lowest lab values same

----check box

check box

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Version 2.4 Changes

Troponin & CK Troponin & CKTroponin & CK

Troponin & CK----MB MB MB MB initial initial initial and initial and peak and and peak peak peak ––– date/time –date/time date/time date/time fields removed

fields removedfields removed fields removed

Version 2.4 Changes

Public reporting/ Core Measures

• LVEF measured after discharge

Version 2.4 Changes

Public reporting

• Physician Provider Number (NPI)

Admitting Procedure Discharge

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Physician Level Dashboard Reporting

Physician Quality Reporting System

(PQRS)

• Reimbursement

– Promotes reporting of quality information by eligible providers

– Providers identified by NPI #

Limited and Premier Forms- Current

140 fields in Limited vs. 280 fields in Premier

– Simple/Avg pt = 60 - 80 fields vs. 100 - 150 in Premier – Complicated pt = 80 - 100 fields vs. 150 - 200 in

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Limited and Premier Forms- V 2.4

• 160 fields in Limited vs. 260 fields in

Premier

– Addition of fields in Limited include: • EMS fields (Mission Lifeline reporting) • Reasons for no Reperfusion • Location of First Evaluation • “Value out of range” for LDL

Limited and Premier Forms – V2.4

• 25% fewer date/time fields • “Set to no” functionality in ACC

data collection tool

Limited and Premier Forms – V2.4

• Limited form – answering “no” to many parent fields will ‘close’ child fields

– As few as 75 fields for Limited, 120 for Premier

• Referring hospitals can review their performance on care measures provided

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Contact NCDR for questions at Contact NCDR for questions at Contact NCDR for questions at Contact NCDR for questions at [email protected] or call 800

[email protected] or call 800 [email protected] or call 800