action registry action registry ––––gwtg gwtg version 2 · for action registry –gwtg...

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3/8/2014 1 ACTION Registry ACTION Registry ACTION Registry ACTION Registry – GWTG GWTG GWTG GWTG Version 2.4 Version 2.4 Version 2.4 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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3/8/2014

1

ACTION Registry ACTION Registry ACTION Registry ACTION Registry –––– GWTG GWTG GWTG GWTG

Version 2.4Version 2.4Version 2.4Version 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

3/8/2014

2

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 adddetermining what fields to adddetermining what fields to adddetermining what fields to add????

1. Email suggestions

2. RSM calls

3. Focused RSM teleconferences

4. Physician committee meetings

5. All of the above

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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/medicationsNew therapies/medicationsNew therapies/medicationsNew therapies/medications

• Medications

– Dabigatran

– Rivaroxaban

– Apixaban

– Statin therapy at discharge, new fields

• Hypothermia Protocol

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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 you enter the Xarelto in the data 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 (1st 24 hours)

• Ticlopidine date/time & dose (1st 24 hours)

• Prasugrel dose (1st 24 hours)

• Beta blocker date/time

• Duration of P2Y12’s at discharge

• Option of blinded

Version 2.4

3/8/2014

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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

• GP IIB/IIIA Inhibitors

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Version 2.4 Changes

• Anticoagulants removed

Section E- Medications

Excessive dosing UFH- no PCI

Documentation:Documentation:Documentation:Documentation:

• 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 PCIThe 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 itentering itentering itentering 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

DocumentationDocumentationDocumentationDocumentation::::

• 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

• 5000 U IV bolus in cath lab administered at 08:15

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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 itentering itentering itentering 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 RegistriesAligning RegistriesAligning RegistriesAligning Registries

• PCI Indications

• Arterial access site

• Demographics/Race Fields

• Mobile ICU

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Version 2.3 Procedure fields

Version 2.4 Changes

• Coronary Stenosis % removed

Version 2.4 – Procedures and Tests

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Version 2.4 Changes

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

Version 2.4 Changes

Hypothermia therapyHypothermia therapyHypothermia therapyHypothermia therapy

Section F- Procedures & Tests

PCI Indication V2.4

Documentation:Documentation:Documentation:Documentation:

• Presents with N/V & chest pressure

• Chest pressure started 2 days ago

• Vomiting started at 08:00, worsening CP

• ECG- ST elevation

• Emergently to cath lab at 09:45

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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 PCI for STEMI (unstable, >12 hrhrhrhr from from from from sxsxsxsx onset)onset)onset)onset)

3.3.3.3. PCI for STEMI PCI for STEMI PCI for STEMI PCI for STEMI (stable(stable(stable(stable, >12 , >12 , >12 , >12 hrhrhrhr from from from from sxsxsxsx onsetonsetonsetonset))))

Version 2.4 Additions

DemographicsDemographicsDemographicsDemographics---- Race detail linesRace detail linesRace detail linesRace detail lines

Section A- Demographics

Hispanic or Latino Ethnicity

Documentation:Documentation:Documentation: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 #72

How How How How would you would you would you would you answer Hispanic or Latino 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 GuidelinesResearch/Clinical GuidelinesResearch/Clinical GuidelinesResearch/Clinical Guidelines

• Additional In-Hospital Clinical events

• Home Functioning/Cognitive Status

In-Hospital Clinical Events

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Version 2.4 Changes

Home FunctioningHome FunctioningHome FunctioningHome 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

• Detail under Cerebrovascular disease

3/8/2014

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Version 2.4 Changes

Collaborative/Integrated CareCollaborative/Integrated CareCollaborative/Integrated CareCollaborative/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 nonTwo FMC fields to capture nonTwo FMC fields to capture nonTwo FMC fields to capture non----EMS FMCEMS FMCEMS FMCEMS FMC

NonNonNonNon----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

ContactContactContactContact

Version 2.4 Changes for FMC

Section B- Admission

Means of Transport to First Facility

Documentation:Documentation:Documentation:Documentation:

• EMS called to home of female with symptoms of ACS

• BLS unit dispatched, ALS unit arrived 5 minutes later

• 12 Lead ECG read- ST elevation

• ASA is administered

• ECG reading phoned into ED

• ALS unit transported to primary PCI hospital

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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

3. Leave time blank

3/8/2014

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Data Collection FormStarting with January 1, 2014 discharges

Enter into Auxiliary field 4 the response to question:

Was EMS the first medical contact?

Data Collection ToolEnter “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

Version 2.4 Changes

3/8/2014

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Version 2.4 Changes

Improved quality of data in registry Improved quality of data in registry Improved quality of data in registry 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

NonNonNonNon----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

• Immediate Primary PCI

3/8/2014

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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 DGeographic concerns with DGeographic concerns with DGeographic concerns with D2222B patientsB patientsB patientsB patients

Version 2.4 Changes

Initial Initial Initial Initial & peak or lowest lab values same & peak or lowest lab values same & peak or lowest lab values same & peak or lowest lab values same ----

check boxcheck boxcheck boxcheck box

3/8/2014

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Version 2.4 Changes

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

fields removedfields removedfields removedfields removed

Version 2.4 Changes

Public reporting/ Core MeasuresPublic reporting/ Core MeasuresPublic reporting/ Core MeasuresPublic reporting/ Core Measures

• LVEF measured after discharge

Version 2.4 Changes

Public reportingPublic reportingPublic reportingPublic reporting

• Physician Provider Number (NPI)

�Admitting

�Procedure

�Discharge

3/8/2014

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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

Premier

– Non PCI centers 60 fields vs. 100 in Premier

Strongly encourage participants to use Premier

data set, especially P-PCI capable centers

3/8/2014

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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

3/8/2014

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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 [email protected] or call [email protected] or call [email protected] or call 800----257257257257----4737473747374737