CED Data SourcesAHRQ Annual Conference

September 2010

James A Rollins, MD, MSHA, PhDCoverage and Analysis Group

Office of Clinical Standards and QualityCenters for Medicare & Medicaid Services

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Current CED Data Sources

• ICD Registry

Created by the American College of Cardiology Foundation

• NOPR

National Oncologic PET Registry

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ICD Registry and Variables Collected

• Demographic informationName

SSN

Patient ID

Date of Birth

Race

Ethnicity

Gender

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History of Risk Factors

• History of Heart Failure• Duration of Symptoms• Prior hospitalization for HFM, Timeframe• NYHA Functional Classification• Prior Heart Transplant • Non-Ischemic Dilated Cardiomyopathy

Timeframe• Syncope, Family Hx of Sudden Death

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History and Risk Factors (cont.)

• On Transplant Waiting List• Atrial Fibrillation/Flutter• Ventricular Tachycardia (Hemodynamic

instability)• Cardiac Arrest• Syndrome w/Risk of sudden death• Previous ICD (date, implant site, reason,

primary or secondary prevention

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History and Risk Factors (cont.)

• Ischemic Heart Disease• Prior MI• Prior PCI• Prior CABG

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Diagnostic Studies

• LVEF Assessed• Electrophysiologic Study (study timeframe,

ventricular arrhythmias induced, VT ablation performed, EP study findings)

• Lead ECG w/Automated Measurements• PR interval• QRS duration

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Diagnostic Studies

• Cardiac Rhythms• Abnormal Intraventricular Conduction

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ICD Implant/Explant

• ICD Indication

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NOPR Registry and Variables Collected

• DemographicsName

SSN

Patient’s 5 Digit Zip Code

Date of birth

Race

Ethnicity

Gender

Date of Procedure

PET Facility ID# 10

Specific Reason for PET Study

• Restaging• Suspected Recurrence• Monitoring Treatment Response

during chemotherapy

during radiation therapy

during combined modality therapy

Diagnosis (Leukemia only)

Diagnosis/Paraneoplastic (Leukemia only)

Initial Staging (Leukemia only)11

Cancer Type (ICD-9 Code)Stomach (151)

Small Intestine (152)

Anus (154)

Liver and intrahepatic bile ducts

(155)

Gall bladder & extrahepatic bile

duct (156)

Pancreas (157)

Retroperitoneum and

peritoneum (158)

Lung, small cell (162)

Pleura (163)

Thymus, heart, mediastinum (164)

Kaposi sarcoma (176)

Uterus, unspecified (179)

Uterus, body (182)

Prostate (185)

Testis (186)

Penis and male genitalia

(187)

Bladder (188)

Kidney and other urinary tract (189)

Eye (190)

Primary Brain (191)

Leukemia (204-208)

Neuroendocrine tumor (209)

Metastatic cancer unknown (203)12

Cancer Type

• Has this cancer diagnosis been pathologically proven?

• Unknown primaries: Dominant site of pathologically proven or strongly suggested metastatic disease

e.g., Lymph node, lung, liver, brain, bone, other

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Stage Before PET Scan

• No evidence of disease• Localized only• Regional by direct extension or lymph node• Distant metastasis with single suspect site• Distant metastasis with multiple susp. sites• Unknown or uncertain

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Patient Performance Status

• Asymptomatic, fully active• Symptomatic, fully ambulatory• Symptomatic in bed <50% of the day• Symptomatic in bed >50% of the day• Bedridden, completely disabled

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Monitoring Treatment Responses

• Is the current ongoing treatment intended to be – Curative or palliative?

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Management Plans

• If PET were not available, what management strategy would be used?

Observation (with close follow up)

Additional Imaging (CT, MRI, other NIT)

Tissue Biopsy (surgical, percutaneous, endoscopic

Treatment

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Management Plan (cont.)

• Treatment GoalsCurative

Palliative

Types of Treatment

Surgical

Chemotherapy

Radiation

Supportive Car

Will treatment be directly provided by you?18

CED Data Sources

• The website for the source to Medicare data is http://www.resdac.umn.edu/

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