bcis audit returns adult interventional procedures 2002

BCIS Audit Returns Adult Interventional Procedures

2002

Peter F Ludman BCIS National Audit Officer

On behalf of

British Cardiovascular Intervention Society

Brighton 2003

Audit Domains

•  Structure •  Appropriateness •  Process •  Outcome

UK Intervention Centres

52 52 53 54 54 5358 61 63 66 64 64

01020304050607080

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

No.centres

64

65

PCI centres

Angiography only Centres

2002

UK Interventional and Diagnostic centres 2002

No. No cath data

(%)

Caths*

(% of total)

PCIs

(% of total)

NHS Interventional

48 0 115,681 (70%)

42,007 (94%)

Private Interventional

16 1 (6%)

10,021 (6%)

2,906 (6%)

Diagnostic only

65 12 (18%)

39,471 (24%)

TOTAL 129 165,173 44,913

*Missing data assumed to be equal to previously reported activity

Centres not reporting diagnostic numbers

•  Interventional –  Harley Street

•  Diagnostic only –  Ayr Hospital –  Derbyshire Royal Infirmary –  Inverclyde Royal Hospital –  Lister, Stevenage –  Mayday University Hospital –  Nevill Hall Hospital,

Abergavenny –  Northwick Park Hospital –  Rotherham Hospital –  Royal Gwent, Newport –  Salisbury District Hospital –  St Mary's, Portsmouth –  Sunderland Royal Hospital

Angiograms per PCI

5.2

4.3

5.7

3.84.1

3.5

4.3

2.8

4

2.8

3.7

0

1

2

3

4

5

6

1997 1998 1999 2000 2001 2002

Angio/PCI (PCI centres)

Angio/PCI (all UK)

Angiography : PCI rates Europe 2000

0

1

2

3

4

5

6

7

Ratio Angio : PCI

Lux Ice Fra Bel NorSwi

PolSpa Ita Cze Gre Fin Ger Aus Por UK

UK 2002 Hun

Annual Procedures per cath lab (NHS centres)

Mean Median Range Interventional labs Procedures (pa) per lab

1159 1148 437 to 2480

Procedures (pa) per No of weekly sessions

149 131 49 to 346

Diagnostic labs Caths (pa) per lab*

740 609 150 to 2300

Caths (pa) per No of weekly sessions*

173 153 50 to 512

*Mobile lab excluded

Interventional centres providing NO DATA

•  None

Number of PCIs performed in NHS Centres (total per annum)

0

2

4

6

8

10

12

<200 <400 <600 <800 <1000 <1200 <1400 <1600 <1800 <2000 >=2000

200020012002

Total UK PCI Procedures Year Centres Total

Procedures Rate per million Increase

(%) 1991 52 9,933 174 1992 52 11,575 203 16.5 1993 53 12,937 227 11.8 1994 54 14,624 256 13.0 1995 54 17,344 304 18.6 1996 53 20,511 359 18.1 1997 58 22,902 402 11.7 1998 61 24,899 437 8.7 1999 63 28,133 494 13 2000 66 33,652 590 20 2001 64 38,992 664 12.5 2002 64 44,913 759 14.3

Rate of increase in Procedure numbers per million

0

5

10

15

20

25

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Rat

e of

Incr

ease

(%)

Change in population estimate

590664

759

0100200

300400500

600700800

Rate per Million

'85 '88 '90 '92 '94 '96 '98 '00 '02

Year

PCI Rates per million population (UK)

Assumes UK population of: 58.8 m mid 2001, 59.2m mid 2002

Total PCIs in the UK Countries (2000 to 2002)

135 886119 922137711830072618

25610

30785

15423485

2159 11311498

40722787

35306

0500010000150002000025000300003500040000

EnglandNHS

EnglandPrivate

ScotlandNHS

ScotlandPrivate

N. Ireland Wales

200020012002

Total No.s of PCI

PCIs/million UK Countries (2000 to 2002)

0100200300400500600700800900

1000

England Scotland N. Ireland Wales

200020012002

NSF

NB Wales data does not include those treated in England

Rates of PCI (Commissioned in England 2002/3)

0

200

400

600

800

1000

1200

Rat

e pe

r mill

ion

North W

est Lond

on

South W

est Peni

nsula

South W

est Lond

on BBC

South East

Londo

n

Surrey a

nd Suss

ex

North, T

yne a

nd Wear

Leics, N

orthant

s & Rutla

nd

Hampshire

& IO

W

Co Durh

am &

Tees V

alley

Thames

Valley

West Yorkshire

N & E Yorks

and N

Lincs Essex

Dorset

& Somers

et

North Cent

ral Lond

on

North East

Londo

nBed

s and

Herts

Greater

Manche

ster

South Yorks

hire

Norfolk

, Suff

olk an

d Cam

bs

Kent an

d Medway

West M

idlands S

outh

Cumbria &

Lancas

hire

Trent

Shropshire

and S

taffs

Avon,

Gloucs

& Wilts

Cheshire

& M

erseys

ide

NSF

PCI rates versus SMR (Commissioned in England 2002/3)

0

200

400

600

800

1000

1200

0.8 0.9 1 1.1 1.2 1.3

SMR

Rat

e pe

r mill

ion

Correlation coefficient - 0.3 (p = NS)

PCI vs Isolated CABG Numbers (UK) Data from BCIS and SCTS Registry

05000100001500020000250003000035000400004500050000

'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02

BCISSCTS

1.3 1.5 Ratio PCI:CABG ? 1.7

PCI vs CABG breakdown (Commissioned in England 2002/3)

0200400600800

10001200140016001800

North W

est Lo

ndon

South

West P

enins

ula

Co Durh

am &

Tees V

alley

Essex

Dorset

& Somers

et

N & E York

s and

N Linc

s

Cumbri

a & La

ncas

hire

BBC

North,

Tyne an

d Wear

South

West L

ondo

n

Greater

Man

ches

ter

Hamps

hire &

IOW

South

East L

ondo

n

South

Yorksh

ire

Surrey

and S

usse

x

West Yorks

hire

Thames

Valley

Leics

, Nort

hants

& Rutl

and

Norfolk

, Suff

olk an

d Cam

bs

Shrops

hire a

nd Staf

fs

North C

entra

l Lon

don

Beds a

nd H

erts

Chesh

ire & M

ersey

side

Kent a

nd M

edway Trent

West Midl

ands

Sou

th

North E

ast L

ondon

Avon,

Gloucs

& W

ilts

Rat

e pe

r mill

ion

CABG pmp PCI pmp

Ratio 1.4 : 1

PCI and CABG rates per million (Europe 2000)

0

500

1000

1500

2000

2500

Pol Gre Spa Hun Por Fin UK Ita Bel Cze Nor Lux Fra Ice Swi Aus Ger

PCICABG

1.8 1.4 4.2 0.7

2.0 0.9

1.3

2.8 1.4

2.0

1.7 4.1 5.4

3.3 2.4

3.0

2.3

Ratio PCI:CABG

Ratio PCI: CABG (Europe 2000)

0

1

2

3

4

5

6

Rat

io P

CI:C

AB

G

Hun Fin UK UK2002

Gre Bel Nor Pol Por Cze Ger Swi Ita Aus Ice Lux Spa Fra

No. of Interventional Consultants (NHS centres, UK 2002)

0

2

4

6

8

10

12

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18No of Consultants per Centre

No

of C

entr

es

Mean 2000 5.5 2001 6.1 2002 6.5

Total = 312 Includes local and visitors, cardiologists and radiologists

No of PCIs per Consultant (NHS Centres)

data from 48 centres

0

5

10

15

20

25

No

of C

entr

es

0-50 51-100 101-150 151-200 201-250 >250

No PCIs/Consultant

2001 2002

Note: data from institutional volume divided by No operators per institution

Mean PCI/consultant: 2000 125 2001 126 2002 138

Visiting Interventionists (NHS Centres 2002)

1830

84

123105

0

20

40

60

80

100

120

140

Centres with no Visitors Centres with Visitors

No of Centres No of Local Int. No of Visitors

4.7 Interventionists/Centre Mean: 156 PCIs/year

7.6 Local + Visitors/Centre Mean: 127 PCIs/year

Surgical cover (Data for 2002)

On site Off site No of centres 53 11 No. of PCI (% of total)

39763 (89%)

5150 (11%)

Mean No. procedures per centre

750 468

Operator volume: PCIs per interventionist *

149 100

* NHS Centres only

Audit Domains


Appropriateness

•  Indications –  Severity of symptoms –  Objective assessment of myocardial ischaemia –  Angiographic disease severity –  etc.

•  Risk stratification –  Clinical presentation –  LV function –  Renal function –  etc.

Audit Domains


Minimum Data (form B) Minimal or No data from:

•  No data –  None

•  Minimal Data –  None

Stent procedures 1992 - 2002 2002 data from 63 of 64 centres

84 86 86.4

0102030405060708090

100

% of Procedures

'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02

Year

Stenting in different centres 1998-2002

2002 data from 63 of 64 centres

05

10152025303540

No

of C

entr

es

31-40 41-50 51-60 61-70 71-80 81-90 >90

% Procedures using Stents

19981999200020012002

PCI for Restenosis 1998 - 2002 (2002 data from 48 of 64 centres)

0%

10%

20%

30%

40%

50%

60%

70%

% of Centres

0-5 5.1-10 10.1-15 >15% procedures for Restenosis

19981999200020012002

PCI in patients with past CABG 2002 (Data from 45 of 64 centres)

0

5

10

15

20

25

No of Centres

0 to 5 5.1 to 10 10.1 to 15 15.1 to 20 20.1 to 25 25.1 to 30

% of procedures in patient with CABG

Note: Includes procedures on native vessels and grafts

Mean 8.4%

Use of GP IIb/IIIa blockers 2002 data from 62 of 64 centres

05

1015202530354045

% of Procedures

1997 1998 1999 2000 2001 2002

with Abciximabwith any GPIIb/IIIa

Note: Possible underestimate of small molecule use

Abciximab in different centres 1999 - 2002


0

5

10

15

20

25

30

No. of Centres

0 to 10

11 to

20

21 to

30

31 to

40

41 to

50

51 to

60

61 to

70

71 to

80

81 to

90 >90

% Procedures using Abciximab

1999200020012002

Abciximab use by Clinical Presentation (2002 data from 47 of 64 units)

28.5

48.9

27.738.1

52.559.6

01020304050607080

% Procedures

with Abciximab

SV no CTOMV no CTO SV CTO

MV & CTO NSTEMI STEMI

Other Coronary Interventional Techniques (1)


Units No ∆ % cf 2001

* % of all procs

** Mean

*** Range

Rotablation 27 170 +17 0.38 6.3 1-37 Atherctmy (DCA) 7 13 -54 0.03 1.9 1-4 TEC 1 12 +300 0.03 12 12 Laser 5 15 -35 0.03 3 1-9 Cutting ballon 47 1226 +37 2.7 26.1 1-93 Thrombectomy ¥ 20 147 +153 0.39 8.7 1-37 Brachytherapy 7 143 +10 0.32 20.4 7-52

*% of all UK interventional procedures **Mean number in units using the technique ***Range in units using the technique

¥PercuSurge, Rescue, Angiojet, X-sizer

Other Coronary Interventional Techniques (2)



* % of all procedures

** Mean

*** Range

PTMR 1 28 +47 0.06 28 28

Septal ablation 2 4 +100 0.01 2 1-3

Distal protection

9 68 +94 0.15 7.6 2-19

Self reported data not specially requested


Non coronary cardiac intervention 2002 data from 62 of 64 centres


% of all procedures

** Mean

*** Range

MV plasty 33 199 -20 0.44 6 1-23

AV plasty 6 6 -65 0.01 1 1

PV plasty 9 26 -10 0.06 2.9 1-8

TV plasty 1 1 0.002 1 1

PDA 8 23 -44 0.05 2.9 1-6

ASD* 23 335 +13 0.75 14.6 2-51

PFO* 15 93 +158 0.2 6.2 1-28

VSD (self reported) 2 8 +167 0.02 4 4

* Some centres give combined data for ASD/PFO closure

Mitral Balloon Valvuloplasty 2002

22

5 3 2 10

5

10

15

20

25

Number of centres

1-5 6-10 11-15 16-20 21-25No of procedures performed

33 of 64 centres perform MBV

Great vessel intervention 2002 data from 62 of 64 centres


* % of all procedures

** Mean

*** Range

Coarct / Re-coart 7 33 +27 0.07 4.7 1-17 Carotid 4 76 +3700 0.17 19 1-70

Data below not specifically requested

Pulm art 2 10 0.02 5 1-9 SVC 2 7 0.02 3.5 2-5 Aorta 1 2 0.004 2 2

Other Diagnostic Techniques 2002 data from 62 of 64 centres


*% of all procedures

** Mean

*** Range

IVUS 36 877 +32.5% 2.0 24.4 1-217

Angioscopy 0 0 0 0 0

Data below not specifically requested Press wire 7 137 +83% 0.3 19.6 1-44

Flow wire 0 0 0 0 0


Other procedures 2002 data from 62 of 64 centres


* % of all procs

** Mean

*** Range

Foreign body removal

5 16 0.04 3.2 1-11

Embolisation 8 24 0.05 3 1-9

Groin closure 48 15,700 +85 35.0 327 4-3100

Data below not specifically requested Pericardiotomy 1 1

Spinal cord stimulator

1 22 0.002 22 22

Audit Domains


ANY Outcome Data (form C) Inadequate or No Data

•  City Hospital, Birmingham

•  Yorkshire Heart Centre •  University Hosp. Of Wales •  Edinburgh Royal

Infirmary •  London Chest •  Freeman, Newcastle •  Northern Gen. Hosp.

Sheffield •  St Bartholomew's •  Plymouth Derriford

•  Ross Hall Hospital •  London Independent •  St Anthony's •  The Priory, Birmingham •  HCI, Glasgow (Golden

Jubilee National Hospital) •  Harley Street Clinic •  Yorkshire Clinic, Bradford •  BUPA Lea (Cambridge)

HOSPITAL outcome Data (form C)

No data from: •  Cath lab only

–  Blackpool Victoria –  Yorkshire Heart Centre –  St Mary's –  Papworth Hospital –  Glasgow Western Infirmary –  Wythenshawe, Manchester –  City Gen. Hosp. Stoke –  Hairmyres –  BMI Alexander, Manchester –  London Bridge Hospital –  BUPA Leicester –  Cromwell –  The Priory, Birmingham –  Yorkshire Clinic, Bradford –  BUPA Lea (Cambridge)

•  Unspecified –  Belfast City –  Hull RI & Castle Hill –  Walsgrave Hospital, Coventry –  Manchester Royal Infirmary –  Heart Hospital (Middlesex/

UCH –  Northern Gen. Hosp.

Sheffield –  St George's –  Eastbourne –  Wellington Hospital –  BUPA Leeds –  Ross Hall Hospital –  London Independent –  St Anthony's –  Harley Street Clinic –  Bristol BUPA –  Park, Nottingham

All PCI Procedures: Mortality Year Data

From: Total with

mortality data Mortality % Range %

1991 9,071 (9,933) 0.48

1992 43/52 10,483 (11,575) 0.71 0-3.5

1993 44/53 11,859 (12,937) 0.59 0-2.7

1994 44/54 12,598 (14,624) 0.60 0-2.7

1995 35/54 11,365 (17,344) 0.69 0-3.4

1996 37/53 14,476 (20,511) 0.72 0-3.2

1997 41/58 17,577 (22,902) 0.91 0-10

1998 44/61 16,946 (24,899) 0.80 0-9.1

1999 48/63 20,975 (28,133) 0.61 0-4

2000 48/66 24,323 (33,652) 0.64 0-2.6

2001 45/64 29,001 (38,992) 0.75 0-2.8

2002 53/64 37,437 (44,913)

0.54 0-1.9

Includes all centres reporting cath lab outcome or hospital outcome

All PCI procedures: Outcome Year Vessels/

case Success

(%) MI (%)

Re PCI for acute closure

(%)

Em. CABG

(%)

Mortality (%)

1991 86 1.6 2.6 0.48 1992 1.17 88 1.4 2.0 0.71 1993 1.09 89 1.1 1.9 0.59 1994 1.15 90 1.0 1.6 0.60 1995 1.17 89 1.4 1.9 0.69 1996 1.17 90 1.4 1.7 0.72 1997 1.16 92 1.2 1.1 0.89 1998 1.24 92 0.8 0.7 0.80

1999 1.11 90 0.57 0.48 0.61

2000 1.21 92 0.6 0.4 0.64

2001 1.22 94 0.5 0.4 0.75

2002 1.23 (52 of 64)

92 (51 of 64)

0.57 (49 of 64)

0.33 (50 of 64)

0.28 (53 of 64)

0.54 (53 of 64)

Includes all centres reporting cath lab outcome or hospital outcome

All Procedures: Outcome

0.0

0.5

1.0

1.5

2.0

2.5

3.0

'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02

%Mortalityem CABG

Stenting and outcome 1992-2002 2002 CABG data from 53, resten data from 48 of 64 centres

Year % Stented % PCI for Restenosis

% needing Em.CABG

1992 2.7 11.6 2.0 1993 5.6 12.3 2.0 1994 13.5 11.4 1.8 1995 27.6 9.6 1.9 1996 45.9 9.4 1.5 1997 60 7.4 1.1 1998 69 5.2 0.6 1999 79 4.8 0.48 2000 85 6.2 0.4 2001 87 5.4 0.4 2002 84 4.7 0.28

Stenting and the need for emergency CABG

(2002 data from 53 of 64 centres)

0

10

20

30

40

50

60

70

80

90

100

'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02

Year

% s

tent

0

0.5

1

1.5

2

2.5

% E

m C

AB

G

% Stent% Em.CABG

Stenting and procedures for restenosis

(2002 data from 48 of 64 centres)

0

10

20

30

40

50

60

70

80

90

100

'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02

Year

%

0

2

4

6

8

10

12

14

% % Stent% Restenosis

Centres providing complete data on HOSPITAL outcome

(2002)

•  Aberdeen Royal Infirmary •  Belfast Royal Victoria •  Birmingham Heartlands •  University Hospital,

Birmingham •  Guy's and St Thomas‘ •  Bristol Royal Infirmary •  Hammersmith Hospital •  Harefield Hospital •  Kings College Hospital •  Edinburgh Western •  Liverpool CTC •  John Radcliffe, Oxford

•  Royal Brompton Hospital Glenfield, Leicester

•  Royal Free •  Southampton University

Hospital •  James Cook, Middlesbrough •  Nottingham City •  KE VII, Midhurst •  Morriston, Swansea •  Royal Sussex, Brighton •  RCH Truro, Treliske •  Taunton & Somerset

Hospital Outcome 2002 Data from 23 centres

No.

Success Partial Success

Failed Repeat PCI

CABG MI Death (Range)

19606 91.5% 2.5% 3.8% 0.3% 0.24% 0.6% 0.66% (85-97) (0.5-5.4) (0.5-9.5) (0-0.7) (0-1.1) (0-3.9) (0-1.8)

All Patients


No.


Repeat PCI


Stable Single Vessel (no CTO)

7770 95% (87-100)

1.1% (0-4.7)

0.26% (0-0.96)

0.17% (0-1.4)

0.3% (0-2.8)

0.14% (0-0.78)

Stable Multivessel (no CTO)

2434 91.9% (63-100)

5% (0-10.3)

0.08% (0-0.9)

0.29% (0-0.3)

0.62% (0-4.3)

0.33% (0-2.9)

Single Vessel CTO

1081 68.4% (44-100)

2.4% (0-10)

0.18% (0-1.4)

0.65% (0-5.4)

0.28% (0-3.1)

0.1% (0-1.0)

Multivessel Inc. CTO

814 83.7% (33-100)

11.3% (0-40)

0%

0%

0.39% (0-4.3)

0% 0

All data (cath lab, hosp outcome and unspecified) – 46 centres Stable Single Vessel (no CTO)

12,983 95% (78-100)

0.22% (0-1.1)

0.22% (0-1.4)

0.35 (0-3)

0.10% (0-0.8)

Elective Patients


No.


Repeat PCI


CABG pts 1556 81.2%

(16-100) 2.4% (0-8.3)

0.06% (0-1.1)

0.26% (0-4.3)

0.13% (0-2.0)

0.3% (0-1.4)

Restenosis

997 92.2% (69-100)

3.2% (0-31)

0.4% (0-7.7)

0.3% (0-4)

0.7% (0-9)

0.6% (0-9)

Does not account for clinical syndrome CABG patients includes Rx of native and grafts

Patients with previous bypass grafts Patients treated for restenosis


No. Success Partial Success

Repeat PCI

CABG Q MI Death (Range)

ACS 8256 93.6% 1.9% 0.3% 0.2% 0.5% 0.5% (50-100) (0-14) (0-25) (0-3.8) (0-25) (0-14)

Acute coronary syndromes (UA/NSTEMI)

Includes all classified as treated for UA and post MI angina (stable and unstable)


No. Success Partial Success

Repeat PCI

CABG Q MI Death (Range)

Acute closure 78 80.7% 3.8% 3.8% 6.4% 10.3% 10.3% (0-100) (0-20) (0-75) (0-40) (0-100) (0-100)

Patients Rx for acute vessel closure


No.


Repeat PCI

CABG re-MI Death (Range)

Primary PTCA

245 90% (0-100)

3.7% (0-15)

1.2% (0-4.8)

0%

0.8% (0-4.7)

2% (0-8)

Rescue PTCA

558 90% (0-100)

3.4% (0-100)

1.4% (0-12)

0.5% (0-5)

0.5% (0-2.8)

2.2% (0-13)

Re-MI PTCA

389 92% (0-100)

2.0% (0-50)

0.5% (0-100)

0.3% (0-1.8)

1.8% (0-100)

1.5% (0-100)

Shock 154 69% (0-100)

9.7% (0-50)

1.9% (0-50)

0.65% (0-33)

1.3% (0-33)

29% (0-100)

Patients Rx for STEMI

PCI for STEMI (2002 data from 47 of 64 units)

2174

0

500

1000

1500

2000

2500

All STEMI PrimaryPCI

Rescue For Re-MI Shock

20012002

Data from units reporting cath or hosp outcome

4.8% of all PCI activity

Hospital MACE Overview 2002 (Data from 23 centres, 19,606 patients)

0.660.24 0.170.22 0.5 0.2

10.3

6.4

2

0

2.2

0.5 0.3 0.260

2

4

6

8

10

12

%

All

Elective

UA/NSTEMISAT

PPTCAResc

ue

past CABG

Mortalityem CABG

BCIS / CCAD project

•  Dataset 5.1.2 •  Data collection / transmission •  Pilot site experience •  Future plans

Dataset •  Version 5.1

–  Finalised at meeting 12-2-03

•  Dataset –  Sections 1 to 5 (5 = optional fields) –  Modifications

•  Overall structure invariant for 2 years (2005) –  103 fields and short code options

•  Volatile menu items can be updated at short notice (8) –  On BCIS web site and CCAD web site

•  www.bcis.org.uk/ •  www.ccad.org.uk/ccadweb.nsf

BCIS / CCAD

•  Practical issues –  Collecting the data –  Transmitting the data

CCAD Central Server

Local Lotus Notes Database

Encr

yptio

n

The Basic CCAD Package

•  Lotus Notes front end •  Local database •  Encrypted link to CCAD •  Maintained centrally

–  Automatic menu update –  Automatic software update

Limitations: •  One computer for data input •  Difficulties linking with other

hospital systems •  No lesion specific data

Connection to other Databases

Item 1 Item 2 Item 3 Item 103 ……

Patient 1 Patient 2

Patient n

…..

Comma separated values file

CCAD Central Server


Encr

yptio

n

Definition: www.ccad.org.uk See CCAD downloads

PCI Database on

Hospital Server Lab results server

PAS server

Audit clerk

SpR or consultant computer

Cath lab data entry

Fu data entry

Include partial data, updated by subsequent transfers

CCAD Central Server


Encr

yptio

n

CCAD Central Server


Encr

yptio

n

CAD Local

N = 963

CCAD Central Server


Encr

yptio

n

CAD Central

N = 3696

CCAD Central Server


Encr

yptio

n

Data completeness Procedure - indications Procedural details Procedure - outcome

Indications

Indications - detail

CCAD Central Server


Encr

yptio

n

Data completeness Procedure - indications Procedural details Procedure - outcome

Procedure - detail

CCAD Central Server


Encr

yptio

n

Data completeness Procedure – indications Procedural details Procedure - outcome

Outcome

Outcome – detail (1)

Outcome – detail (2)

Analysis of CCAD dataset •  Benchmarking

–  Any unit can compare their practice with UK wide average using Lotus Notes software (as MINAP)

•  ONS link –  Post discharge event free outcome

•  Death, re-intervention etc. •  BCIS Council position

–  Additional analysis to be arranged •  ? via University statistical department

–  Methodology of analysis controlled by the profession via BCIS

–  ? 3 year cycle of results analysis –  Data monitoring committee as a means of peer review –  Accept that the type of analysis will continue to evolve

BCIS / CCAD pilot sites

Name Status IT Tool University Hospital Birmingham

On Line – Sept 2002 Access db (PFL)

James Cook University Hospital

On Line – April 2003 Access db in house development

Royal Brompton Dendrite, link evolving Bristol Cardis, link evolving Exeter Long way off Southampton First download planned

1/04

Walsgrave Hospital Dendrite - Intermittent downloads

Papworth Hospital Tomcat, link evolving Kings College Hospital Dendrite, software failed

Oct 2003

London Chest Hospital Tomcat, link evolving

Plans

•  Pilot sites continue •  Encourage other sites to start

collecting dataset version 5.1 –  decide on system to be used –  contact CCAD for Lotus gateway set up

instructions –  0207 391 8028

•  Full roll out by April 2004

Conclusions •  Steady increase in PCI activity in UK

–  England and Scotland •  NSF rates for PCI have been exceeded

–  Increase in PCI:CABG ratio –  MACE rates remain satisfactory

•  BCIS-CCAD project –  Important progress

Extra Information •  Additional slides with details of

–  Dataset version 5.1 version code –  Volatile menu items

Dataset – Version Code

•  Version history –  5.1 as ‘finalised’ in Feb 2003 –  5.1.1 as presented at London Roadshow –  5.1.2 as presented at Leeds Roadshow

•  Plan to present BCIS and SCTS datasets to ISB Jan 2003


5.1.2


5.1.2 Version 6: After approval of definitions by the Information Standards Board


5.1.2

Increments whenever a new menu item is added to volatile lists (e.g. new DES)

Version 6: After approval of definitions by the Information Standards Board


5.1.2 Version 6: After approval of definitions by the Information Standards Board

Increments whenever a new menu item is added to volatile lists (e.g. new DES)

Increments with subtle changes in text , typos, clarification of definitions etc.

Dataset Maintenance

Central Repository (IA)

Dataset details Field numbers, Field prompts, Short and long codes Definition and notes Format details

Excel Workbook BCIS Web site Dataset

CCAD Lotus Notes Dataset

help text / files

NHS Data Dictionary

Dataset Maintenance

Dataset fields •  Important aspects not contained in current

dataset –  (Structure) –  Appropriateness –  Process –  Outcome

•  Current definitions of clinical syndromes •  Track the use of new equipment

–  Drug eluting stents –  Distal protection –  Etc.

Dataset 5.1 examples

•  Indication for intervention –  1. Stable – angina –  2. Stable – coronary anatomy –  3. ACS – no acute STEMI –  4. ACS - primary PCI for STEMI (no lysis) –  5. ACS – Facilitated PCI for STEMI (lysis + PCI) –  6. ACS – Rescue PCI (failed lysis) –  7. ACS – PCI for re-infarction no lysis –  8. ACS – Rescue PCI for re-infarction (failed lysis) –  9. Staged procedure –  10. Hybrid procedure –  11. Acute / subacute thrombosis at recent PCI site (30/7) –  12. Bail out following diagnostic cardiac catheterisation

Dataset 5.1 – Event Timing STEMI

(anterior ST elevation)

Thrombolysis

Good resolution

More chest pain ST depression

Cath and proceed to LAD PCI

Awaiting ETT pre Dx

Date/time 1

Date/time 2 PCI data

Time: Date/time 2 ECG: ST depression

Volatile menus •  8 fields with volatile menu items

–  Drug Eluting Stents –  Emboli protection –  Diagnostic devices –  Procedural devices –  Thrombus removal –  Brachytherapy –  Arterial access management –  Peri-procedure drugs

Volatile menus

•  Any potential changes to be directed to BCIS audit secretary (PFL) –  Discussed with BCIS Council audit committee –  CCAD informed

•  update dataset version held with Tony Dallimore –  update spreadsheet on BCIS –  update CCAD web site and Lotus Notes

Dataset stakeholders

•  BCIS –  Detailed analysis of most of dataset –  Track activity and changes in patterns of Rx


•  Roger Boyle –  NHS data –  Appropriate professional self regulation

•  DOH (general public) –  Provision of safe care

•  Hospital outcome of stable SV disease

bcis audit returns adult interventional procedures 2002

Documents