action registry-gwtg mission lifeline stemi summit sioux falls, sd november 4, 2010 how will we...

ACTION Registry-GWTG

Mission Lifeline STEMI SummitSioux 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

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

Performance Measures

Quality MetricsACTION Metrics

Door to EKG (within 10 min) STEMI- Acute ADP Receptor Inhibitor Therapy within 24 hours of

arrival_Revascularized Patients Discharged on ADP Receptor InhibitorsADP Receptor Inhibitors Prescribed at Discharge for Medically

Treated PatientsLDL assessment (in-hospital) NSTEMI - Excessive Initial UFH Dosing (>70 U/kg bolus, >15

U/kg/min infusionExcessive 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. LimitedDetailed

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 Registry-GWTG participants

• Strongly encourage participants to use Premier data set, especially PPCI capable centers

Limited Form: Pros and ConsPros

Fewer Data Elements

Less time required for

data abstraction and entry

Accommodating for NonPCI Centers

Great form for new sites to start

ConsNo Excessive dosingReports for Anticoagulants

Lower Level of Recognition

Limited Quarterly Outcomes Report

Data not available to allowPhysicians to participate inPACE project

Premier Form: Pros and ConsPros

Detailed Quarterly ExcessiveDosing Reports forAnticoagulants

Higher level of Recognition

Robust Data Set

Full Quarterly OutcomesReport

Required if Physician participatingin PACE PI-CME project

Cons

More time required for dataabstraction and entry

Answering fields that are lesslikely to pertain to Non-PCICenters

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

Performance Measures

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

ACTION Door-to-Balloon Times –Median Times for Transfer In and Non-Transfer In Patients

Transfer in DTB Times Non-Transfer in DTB Times

123

169

236

62

79

103

Q1 07

120

158

223

60

78

102

Q2 07

116

151

215

57

75

Q3 07

113

156

212

5774

95

Q4 07

Tim

e (m

in)

50

220210

60708090

110100

120130140150160170

200

180190

240230

96

403020

250

100

STEMI Door-to-Balloon Times –Median Times for Transfer In and Non-Transfer In Patients

Transfer in DTB Times Non-Transfer in DTB Times

102

130

182

53

70

88

Q1 08

97

123

165

52

67

84

Q2 08

96

120

157

51

66

Q3 08

94

117

150

50

64

79

Q4 08

Tim

e (m

in)

50

220210

60708090

110100

120130140150160170

200

180190

240230

82

403020

250

100

STEMI Door-to-Balloon Times –Median Times for Transfer In and Non-Transfer In Patients

Transfer in DTB Times Non-Transfer in DTB Times

96

123

159

49

6379

Q1 09

96

117

147

48

61

77

Q2 09

92

112

142

48

62

Q3 09

91

113

143

48

62

76

Q4 09

Tim

e (m

in)

50

220210

60708090

110100

120130140150160170

200

180190

240230

77

403020

250

100

NSTEMI Acute Medication Overdosing Trends

* 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)

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

0%

5%

10%

15%

20%

25%

Q1 2009 Q2 2009 Q3 2009 Q4 2009

UFH*

LMWH#

GP Iib-IIIa

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• J

CAHO 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 formIndividual 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 2011Award Levels Must meet compliance on

composite measuresParticipate 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 ncdr@acc.org