• No results found

Development of a National Out-of-Hospital Cardiac Arrest Surveillance Registry. ICEM Singapore 2010

N/A
N/A
Protected

Academic year: 2021

Share "Development of a National Out-of-Hospital Cardiac Arrest Surveillance Registry. ICEM Singapore 2010"

Copied!
37
0
0

Loading.... (view fulltext now)

Full text

(1)

Development of a National Out-of-Hospital

Cardiac Arrest Surveillance Registry

ICEM Singapore 2010

Bryan McNally, MD, MPH

Assistant Professor of Emergency Medicine Emory University School of Medicine

(2)

Presenter Disclosure Information

Bryan McNally, MD, MPH

Emory University School of Medicine

CARES – Cardiac Arrest Registry to Enhance Survival

FINANCIAL DISCLOSURE:

No relevant financial relationship exists

Funding for CARES is provided by a cooperative agreement from the Centers for Disease Control and Prevention (CDC). Grant number MM-0917-05

(3)

Comilla Sasson, et al. Circulation. Cardiovascular & Quality Outcomes 11/10/09.

Predictors of Survival from Out-of-Hospital (OHCA)

A Systemic Review and Meta-Analysis

(4)

There is significant variation in cardiac arrest incidence and outcome in North America

Published national study on variation in Cardiac Arrest…

…found significant variation in incidence and outcome

Disparity in survival for first arrest rhythm of vfib ranged anywhere from 8- 40%

2/3 of the time, bystanders are not initiating CPR

"In this study involving 10 geographic regions in North America, there were significant and important regional differences in out-of-hospital cardiac arrest incidence and outcome.”

Drastic improvements in the response and treatment of SCD are needed to eliminate the 5 fold differences in survival

(5)

0 20 40 60 80 100 Survival Rate (percent) Time to Defibrillation (minutes)

OHCA is a

Prehospital

Disease

5 10 15 20 25

Survival reduced by ~7-10% each minute defibrillation

(6)
(7)

Domino’s vs. EMS

Hungry?

– 30 minutes call-to door guaranteed.

– Customer input for QI – Cost: $10.95 (plus tip)

Cardiac Arrest?

– Call-to-door time rarely tracked – No performance metrics, no QI – Cost: Priceless

(8)

“Most cities don’t measure their

performance effectively, if at all. They

don’t know how many lives they are

losing, so they can’t determine ways

to increase survival rates.”

(9)

Institute of Medicine Report on EMS

“What is missing is a standard set

of measures that can be used to

assess the performance of the

emergency and trauma care

system within each community, as

well as the ability to benchmark

that performance against

statewide and national

performance metrics.”

(10)

You can‟t manage what

you

can‟t measure!

The first step to improving survival rates is to begin collecting data in order to better understand performance

(11)

Early Access Early CPR Early Defibrillation Early Advanced Care

Disparate outcomes are almost certainly due to timeliness and quality of treatment

What can we attribute the variation in survival to?

(12)

Cardiac Arrest is a leading cause of death in the United States

More deaths result from SCD than AIDS, breast cancer and lung cancer combined

SCD may be under/over-estimated because no uniform national data collection system currently exists in the US

SCD compared to other diseases

157,400 40,600 16,000 300,000 0 100,000 200,000 300,000 16,000 40,600 157,400 AIDS SCD Lung Cancer +40% AIDS Breast Cancer

Total AIDS, Breast & Lung Cancer

214,000

Lung Cancer

Deaths

(13)
(14)

Need for a registry CARES

Data collection mechanism

Makes the data collection process more efficient - linkage between EMS, Hospital and CAD outcome

Benchmarking capabilities

Measurement tool

CARES as a uniform data collection system for OHCA

Data collection into a registry at the regional, state or national level enables providers or EMS systems to benchmark their outcomes and

results with other communities

Allows for identification of strengths and weaknesses used to improve the quality of care

Steps toward making cardiac arrest a reportable disease

(15)
(16)

CARES Candidate States

(17)
(18)
(19)

CARES

Allows communities to determine OHCA

outcomes & identify high risk groups and

neighborhoods

Enables clinical benchmarking to identify

opportunities for improvement and track

the diffusion of new therapies

Promotes accountability to improve the

quality and impact of prehospital care

(20)

Sansio

• Mainframe housed in Duluth, MN USA Internet database system

• https://mycares.net

• HIPAA compliant security Reporting features

• Utstein Survival Reports

• EMS/FR response time reports • Demographic reports

• Excel Export

Unifies EMS, 911 dispatch, and hospital data • Any EMS system throughout US

CARES software is web based

(21)

CARES Surveillance Network

Direct data entry from EMS by desktop, mobile ePCR, or scannable form

CARES staff has access to agency, regional, and national data

Hospital contact enters outcome data at their convenience monthly

CAD data entry when available

(22)

CARES has three methods for EMS data collection

Direct entry online, mobile field entry, and optically scanned forms

Direct entry online Mobile field entry Optically scanned forms

• Data can be entered directly into the registry wherever there is internet connection by CARES EMS contact or EMS field

providers/supervisors

• Data can be automatically extracted from the electronic Patient Care Report which then auto-populates the CARES registry.

• The CARES dataset can be completed in paper format and then optically scanned to populate the registry.

(23)

The State of Hawaii EMS Electronic Patient Care Record (e-PCR) System

(24)

Hospital component

(25)

Ultimate Goals of CARES

Create a model national cardiac arrest registry capable of identifying and tracking all cases in a defined geographic area

Helps EMS and the larger community identify:

• Who is affected

• When and where cardiac arrests occur

• Which elements of the system are functioning well and those that are not • How changes can be made to improve cardiac arrest outcomes

(26)
(27)

National Utstein Data

Number of Utstein Survivors by Site:

Site A - 10 Site E - 8 Site I - 3 Site M - 16 Site B - 2 Site F - 6 Site J - 5 Site N - 4

Site C - 8 Site G - 7 Site K - 4 Your Site - 3 Site D - 13 Site H - 4 Site L - 4

(28)
(29)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Age Groups Vfib/Vtach Unk Shock Unk Unshock PEA Asystole

Initial Rhythm by Age Group

(30)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Age Groups Unkown/Blank Coma Severe CPC Moderate CPC Good CPC N=48 N=34 N=80 N=292 N=492 N=496 N=295 N=164 N=27 N=2

Survivoral by Age Group and Neurological Status

(31)

22/84 11/55 0 908/13215 11/79 29/168 12 /91 89/2740 71/526 95/383 262/1170 76/270 22/254 156/982 0% 5% 10% 15% 20% 25% 30% Airport Educational Institution Farm Home/Residence Hospital Industry Jail Nursing Home/Assisted Living Center Other Physician Office/Medical Clinic Public Building Recreation/Sport Facility Residence/Institution Street/Hwy

Survival Rate

Survival Rate by Location Type

CARES Data 10.1.05-12.31.09

(32)
(33)

>90% Black >90% White 26-100% BCPR 0-10% BCPR

(34)

Private Unwitnessed Private Witnessed Public Unwitnessed Public Witnessed Median Income <$21,600 0.15 0.23 0.28 0.41 Median Income $21,601-$30,500 0.14 0.20 0.25 0.35 Median Income $30,501-$42,000 0.15 0.22 0.30 0.44 Median Income $42,001-$62,000 0.19 0.29 0.38 0.48 Median Income >$62,000 0.28 0.38 0.41 0.55

(35)

CARES Summary

Provides a model for a national OHCA surveillance registry

CARES software integrates EMS, 911, and hospital data

Survival reports provide „real-time‟ feedback

Allows communities to internally & externally benchmark

(36)

CARES Summary

We have learned a great deal about OHCA, but have

failed to translate this into better treatments and outcomes.

Widespread disparities still persist

We need to refocus on the “Chain of Survival”

Use data to improve performance!

(37)

CARES WEBSITE

References

Related documents

a) Depending on the number of assessment instruments/methods stated in your 2018-19 AAP, at least 33% to 50% of your assessment data was collected during the 2018 Fall Semester

Throughout the modern history of generative grammar, the problem of determining the general nature of language has been approached “from top down,” so to speak:

The only authors who have used this approach are Clarke and Surkis.4 If the racial balance constraint is expressed as a proportion of the number of children allocated to

Thanga Pandi and Rajendran (2011) have obtained the non steady- state concentration profiles of the reactant, product and autocatalyst in Gray-Scott model using He’s Homotopy

• Master replies with chunk handle and location of replicas • Client caches info using file name/chunk index as key • Client sends request to one of the replicas (closest)

Copyright © Digital Marketing Institute 2012 – 2015 Professional Diploma in Digital Marketing Module 5 Email Marketing Version 5.0.. Copyright © Digital Marketing Institute 2012

In C. elegans, assessment of ATP levels has until now been carried out in vitro [7-9,23], a method which is accurate but implies the destruction of worms, limits the scalability of

When you open a PDF document using Adobe's Acrobat Reader application, you will notice that most long documents contain an outline structure that is displayed on a pane on the left