Transcript Slide 1

ACTION Registry-GWTG
Mission Lifeline STEMI Summit
Sioux Falls, SD
November 4, 2010
How Will We Measure Our Success
If You Don't Measure It, You Can't Improve It!
Susan Rogers RN, BSN, MSN
Associate Director ACTION Registry-GWTG
Nothing to Disclose
Objectives
1. Verbalize the history of the ACTION
Registry-GWTG
2. Describe the tools available in the ACTION
Registry-GWTG
3. Describe the ACTION Registry-GWTG
recognition process
Purpose of ACTION Registry-GWTG
• National surveillance system for high-risk AMI
patients admitted with STEMI/NSTEMI:
– Assess characteristics, treatments, and outcomes of this
patient population
– Optimize outcomes and management of AMI patients
through implementation of ACC/AHA evidence-based
guideline recommendations in clinical practice
– Facilitate efforts to improve quality and safety of ACS
patient care; and investigate QI methods
The History Behind the
ACTION Registry-GWTG
• ACTION Registry transitioned from CRUSADE and
NRMI Registries
• January 2007 ACTION was established
• May 2008 ACTION merged with AHA GWTG CAD to
become
ACTION Registry-GWTG
• Dec. 31, 2009 GWTG CAD sunset
• Current membership of 640 Hospitals
• Over 205,719 records submitted
Inclusion Population
• Acute Myocardial Infarctions-STEMI & NSTEMI only
• Patient must present to 1st Facility with symptoms of ACS,
within 24 hours of arrival
• Patient must have positive ECG- ST elevation, new LBBB, or
documented Posterior MI
OR
• Positive Biomarkers- Troponin or CK-MB
• Transfer In patients- STEMI must arrive within 72 hours,
NSTEMI within 24 hours
• If presents with any other symptoms, or procedures, the patient
is excluded
Performance Measures
Acute/In-hospital Measures
Aspirin Arrival
STEMI - Any reperfusion (PCI or Lytic)
STEMI - Lytic -Door to Needle (Median Time and % <30min)
STEMI - PCI – D2B (Median Time and % <90min
STEMI - D2B Transfer in (Median Time)
LVSD Evaluation
Discharge Measures
Aspirin
B-blocker
ACE or ARB (EF <40%)
Statin for LDL ≥100mg/dL
Smoking cessation (among smokers)
Cardiac rehabilitation
Quality Metrics
ACTION Metrics
Door to EKG (within 10 min)
STEMI- Acute ADP Receptor Inhibitor Therapy within 24 hours of
arrival_
Revascularized Patients Discharged on ADP Receptor Inhibitors
ADP Receptor Inhibitors Prescribed at Discharge for Medically
Treated Patients
LDL assessment (in-hospital)
NSTEMI - Excessive Initial UFH Dosing (>70 U/kg bolus, >15
U/kg/min infusion
Excessive Initial Enoxaparin Dosing (SQ >1.05 mg/kg)
Excessive Initial GP IIb/IIIa Dosing (Full dose Tirofiban if CrCl<30&
Full dose Eptifibatide CrCl <50, or dialysis with either)
STEMI - Anticoagulant- UFH, enoxaparin, bivalarudin or
fondaparinux (first 24 hours)
Aldosterone Blocking Agents at Discharge (EF<40%, with DM, or
HF)
Premier vs. Limited
Detailed
ACTION Registry-GWTG Premier
• Full ACTION Registry-GWTG data set
• Complete quarterly Outcome Report for
benchmarking
• Report on 17 Core Performance Measures
• Report on 12 Quality Metrics
• Sites will be eligible for Higher level of
Recognition Program
ACTION Registry-GWTG Limited
• 50% of full ACTION Registry-GWTG data set
• Limited quarterly Outcome Report for
benchmarking
• Report on 17 Core Performance Measures
• Report on 7 Quality Metrics
• Lower level of Recognition
Limited and Premier Forms
140 fields in Limited vs. 280 fields in Premier
– Simple/Average patient 60-80 fields vs. 100-150 in Premier
– Complicated patient 80-100 fields vs. 150- 200 in Premier
– Non PCI centers 60 fields vs. 100 in Premier
• Either form is available to all ACTION RegistryGWTG participants
• Strongly encourage participants to use Premier data
set, especially PPCI capable centers
Limited Form: Pros and Cons
Pros
Cons
Fewer Data Elements
No Excessive dosing
Reports for Anticoagulants
Less time required for
data abstraction and entry
Lower Level of Recognition
Accommodating for Non
PCI Centers
Limited Quarterly Outcomes
Report
Great form for new sites to
start
Data not available to allow
Physicians to participate in
PACE project
Premier Form: Pros and Cons
Pros
Cons
Detailed Quarterly Excessive
Dosing Reports for
Anticoagulants
More time required for data
abstraction and entry
Higher level of Recognition
Answering fields that are less
likely to pertain to Non-PCI
Centers
Robust Data Set
Full Quarterly Outcomes
Report
Required if Physician participating
in PACE PI-CME project
Performance Measures
Acute/In-hospital Measures
Aspirin Arrival
STEMI - Any reperfusion (PCI or Lytic)
STEMI - Lytic -Door to Needle (Median Time and % <30min)
STEMI - PCI – D2B (Median Time and % <90min
STEMI - D2B Transfer in (Median Time)
LVSD Evaluation
Discharge Measures
Aspirin
B-blocker
ACE or ARB (EF <40%)
Statin for LDL ≥100mg/dL
Smoking cessation (among smokers)
Cardiac rehabilitation
Site Specific Quarterly Reports
• Composites (12 months)
– Percent of compliance
– Benchmark National
• Line graphs (12 months)
– Breakdown Quarterly performance
• Tables (Quarterly, 12 months)
– Benchmark Like Hospitals, National, Top 10%
– All AMI details, and side by side STEMI and NSTEMI
– Overall AMI Subgroups- Compares composites by race, gender,
age, transfer and non-transfer, DM and non-DM, CrCl patients
National Data Slide Sets
Produced every 6 months
Time (min)
ACTION Door-to-Balloon Times –
Median Times for Transfer In and Non-Transfer In Patients
250
240
230
220
210
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
236
169
123
223
215
212
158
151
156
116
113
120
103
79
62
Q1 07
102
78
60
Q2 07
Transfer in DTB Times
96
95
75
57
74
Q3 07
57
Q4 07
Non-Transfer in DTB Times
STEMI Door-to-Balloon Times –
Time (min)
Median Times for Transfer In and Non-Transfer In Patients
250
240
230
220
210
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
182
165
130
102
123
88
97
84
157
150
120
117
96
82
94
79
70
67
66
64
53
52
51
50
Q1 08
Q2 08
Transfer in DTB Times
Q3 08
Q4 08
Non-Transfer in DTB Times
STEMI Door-to-Balloon Times –
Time (min)
Median Times for Transfer In and Non-Transfer In Patients
250
240
230
220
210
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
159
147
143
142
123
117
96
79
63
49
Q1 09
113
112
96
77
92
91
77
76
61
62
62
48
48
48
Q2 09
Transfer in DTB Times
Q3 09
Q4 09
Non-Transfer in DTB Times
NSTEMI Acute Medication Overdosing Trends
25%
20%
UFH*
15%
LMWH#
10%
5%
GP Iib-IIIa
* Infusion (> 15 units/kg/hr) or bolus (> 70 units/kg)
# Initial dose (> 1.05 mg/kg) or total 24 hr dose (> 10 mg over recommended)
0%
Q1 2009
Q2 2009
Q3 2009
Q4 2009
ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009
On-Demand Reports
Reports that are created “On-Demand”
•
•
•
•
A summary of Patient Level Data
From data submitted through the DQR
Must have Yellow or Green light
The Reports are automatically created
What Reports are available
• ACE Inhibitor/ ARB at Discharge among STEMI & NSTEMI Patients
• Adult Smoking Cessation Advice Counseling among STEMI &
NSTEMI ASA at Arrival among STEMI & NSTEMI Patients
• ASA at Discharge among STEMI & NSTEMI Patients
• Beta Blocker at Discharge among STEMI & NSTEMI Patients
• Statin at Discharge among STEMI & NSTEMI Patients
• Cardiac Rehabilitation Patient Referral among STEMI & NSTEMI
Patients
• Evaluation of LV Systolic Function among STEMI & NSTEMI
Patients
• Door In Door Out Transfer in Patients
• Door to Balloon
• Door to Balloon Transfer in Patients
• Door to Needle
• Reperfusion Therapy among STEMI Patients
Performance Graph
Summary Table
On Demand Patient Detail Page
Export Functionality
™
• The export function of the ACTION Registry ® -GWTG
will allow sites to download and export raw data into an Excel, Tab
Separated, and Coma Separated formats
• 4 Pre-set reports will be available
» JCAHO Measures
» Pre Hospital Care EMS and 1st Hospital
» Acute Care Measures
» Discharge Care Measures
• Availability to export by:
Each section of the data collection form separately
The entire form
Individual data elements
Recognition Criteria
• Patient Volume
– 10 NSTEMI within each quarter; and/or
– 10 STEMI within past quarter
• Previous GWTG-CAD recognition status will
be factored into recognition level if
appropriate
• Data Evaluated will follow calendar year
• Must maintain uninterrupted data
submission for the measurement period.
ACTION Registry-GWTG
Performance Recognition Criteria
For Data Entered in 2011
Award Levels
Must meet compliance on
composite measures
Participate in
Platinum
90% compliance for
> = 8 consecutive quarters
Premier
Gold
90% compliance for
>= 8 consecutive quarters
Premier or Limited
Silver
90% compliance for
>= 4 consecutive quarters
Premier or Limited
Recognition Thresholds
• Recognition Threshold
– Silver Performance-90% performance on
composite measures achieved for 4 consecutive
quarters using the Premier or Limited DCF
– Gold Performance-90% performance on
composite measures achieved for 8 consecutive
quarters using the Premier or Limited DCF
– Platinum Performance- 90% performance on
composite measures achieved for 8 consecutive
quarters using the Premier DCF
Application Process
• Data is reviewed over a calendar year
• Recognition data for Q1-Q4 is aggregated
• Sites are then identified as eligible
• Press release sent to all sites accepting
recognition
• Marketing establishes designation of
professional publications
Why Participation Makes Sense Now
• Unique opportunity for a comprehensive, nationwide
assessment of ACS care
• Guide for future quality improvement efforts
• Facilitate equitable and comprehensive delivery of care
for ACS patients
• Measure your risk-adjusted performance against national
benchmarks
How to join ACTION Registry-GWTG
Go to www.ncdr.com
ACTION Registry-GWTG “How to Join”
Download the appropriate participation documents
If you do not currently participate in an NCDR registry (CARE
Registry®, CathPCI Registry®, ICD RegistryTM), sign the
NCDR Master Agreement and the ACTION Registry-GWTG
Addendum
If you currently participate in an NCDR registry, sign the
ACTION Registry-GWTG Addendum
Thank
You
ACTION Registry-GWTG
Phone 800-257-4737
Email [email protected]