The ACC National Cardiovascular Data Base(NCDR) · The ACC National Cardiovascular Data...
Transcript of The ACC National Cardiovascular Data Base(NCDR) · The ACC National Cardiovascular Data...
The ACC National Cardiovascular
Data Registry(NCDR)
Quality Management
Opportunities within the
Cardiac Cath Lab
Brenda Springer, RN BSN
Database Specialist
• Parkview Health Systems
• Sixteen plus years of Cath Lab Experience
• Four years Critical Care Experience
• Managing the Cath/PCI Database since its
inception, 2002
The ACC National Cardiovascular Data
Registry(NCDR)
I have nothing to disclose
Goals for today
• Raise awareness of the what the Cath/PCI
Registry can do for cardiologist practicing in
the cath lab
• Promote communications between data
abstractors and cardiologist
History of the ACC NCDR Cath/PCI
Registry
• Oldest of the six ACC NCDR registries--launched 1997
• Voluntary
• Comprehensive measurement system of data elements and standarized definitions
• Focus on quality in the Cath Lab
• Over 1046 sites enrolled. With 856 sites submitting data
• Over Two million Cath/PCI records
• Multi-phased audit program
• PCI Mortality is Risk Adjusted
• 192 Data Fields for PCI Registry version three
• Version four will have 254 beginning July 1,2009
• Parkview has 13,876 patient records and growing everyday
NCDR Registries
• Care Registry (Carotid Artery
Revascularization and Endarterectomy
Registry
• ICD Registry
• ACTION Registry—GWTG
• IC3 (Improving Continuous Cardiac Care)
• IMPACT Registry (Improving Pediatric and
Adult Congenital Treatment)
How data is collected and distributed at
Parkview
• Interface from HIS to Cath Lab Hemo System
to Cath/PCI software
• Chart Audits
• All demographics are interfaced
• Five fields for patient history are interfaced
• Small amount of “Intra” Cath Lab data is also
interfaced
What can be obtained from this
database?
• Physician Specific Reports
• Hospital Specific Reports
• Door to Balloon Times
• Data Cleansing
Cath/PCI Information Output
• Sample of reports created exclusively through
the Cath/PCI software
• Sample of reports created using the quarterly
ACC NCDR reports
ST Elevated MI(STEMI) Non-Transfers
Arrival to Parkview Randallia
Reported in minutes
79
75
77
82
70
72
74
76
78
80
82
Parkview 79 75 77 82
2007Q3 2007Q4 2008Q1 2008Q2
Primary PCI for STEMI
Indicate whether the PCI procedure is being performed for purposes of
reperfusion in the presence of an acute MI documented in the medical record.
Percentage of total PCI Patients
18.5%
15.3%
17.8%
19.2%
17.7%
14.9%
12.9%
0.0%
5.0%
10.0%
15.0%
20.0%
Parkview 18.5% 15.3% 17.8% 19.2% 17.7%
Like Hospitals 14.9%
All Hospitals 12.9%
2007Q2 2007Q3 2007Q4 2008Q1 R4Q
Average Fluoro Exposure per Interventional MD
PCI Procedures
Quarter Two 2008
14.2
13.112.5
11.3
8.1
11.3
12.3
8.17.8
9.810.3
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Minutes
Average Fluoro Time 14.2 13.1 12.5 11.3 8.1 11.3 12.3 8.1 7.8 9.8 10.3
1 2 3 4 5 6 7 8 9 10 11
Average Contrast Use per Interventionalist
2008 Quarter Two
237
12
171
5
156
41
227
9
201
22
204
25
186
7
172
15
277
26
146
19
237
41
0
50
100
150
200
250
300
1 2 3 4 5 6 7 8 9 10 11
Pink denotes average contrast use
Orange denotes number of PCI procedures
Average Door to Balloon Time per Interventionalist
2008 Quarter Two
(Reflected in Minutes)
83
65
82
0
104
50
77 79
71
92
99
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11
“0” refers to NO STEMI cases performed in this quarter.
Risk Adjusted Mortality Rate
All PCI Patients
(line 1736)
0.00%
0.50%
1.00%
1.50%
Parkview 1.29% 0.85% 0.89% 1.29% 1.12%
Like Hospitals 1.25%
All Hospitals 1.22%
2007Q2 2007Q3 2007Q4 2008Q1 R4Q
American College of Cardiology(ACC) National Cardiovascular Data
Registry(NCDR)
Cath/PCI Data Base
Survival Rates
98.2%
98.4%
98.6%
98.8%
99.0%
99.2%
Parkview Hospitals 98.9% 99.0% 98.5% 99.1%
Like Hospitals 98.8% 98.8% 99.0% 98.9%
All Hospitals 98.9% 98.8% 99.0% 99.0%
2008Q1 2007 2006 2005
Angiographic Success for Acute PCI (STEMI only)
(Calculated per Lesion Success)
(line 1870)
92.0%
93.0%
94.0%
95.0%
96.0%
97.0%
98.0%
99.0%
Parkview 94.9% 98.3% 94.7% 97.0% 96.1%
Like Hospitals 94.7%
All Hospitals 94.9%
2007Q2 2007Q3 2007Q4 2008Q1 R4Q
PCI Procedures with Primary PCI
Successful Primary PCI Rate
(line 1886)
80.0%
85.0%
90.0%
95.0%
100.0%
Parkview 90.7% 91.4% 88.1% 97.6% 91.9%
Like Hospitals 88.6%
All Hospitals 88.7%
2007Q2 2007Q3 2007Q4 2008Q1 R4Q
Aspirin on discharge
All PCI Patients with ACS
(line 1581)
94.0%
95.0%
96.0%
97.0%
98.0%
99.0%
100.0%
Parkview 98.9% 100.0% 99.4% 98.8% 99.3%
Like Hospitals 96.3%
All Hospitals 96.7%
2007Q2 2007Q3 2007Q4 2008Q1 R4Q
Beta Blocker on discharge
Among Patients with STEMI
All PCI Patients
(line 1585)
90.0%
92.0%
94.0%
96.0%
98.0%
100.0%
Parkview 100.0% 100.0% 100.0% 100.0% 100.0%
Like Hospitals 94.3%
All Hospital 94.3%
2007Q2 2007Q3 2007Q4 2008Q1 R4Q
ACE Inhibitor/ARB on discharge
Among Patients with EF <=40%
All PCI Patients
(line 1583)
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Parkview 91.2% 93.1% 86.4% 93.5% 90.6%
Like Hospitals 76.5%
All Hospitals 78.0%
2007Q2 2007Q3 2007Q4 2008Q1 R4Q
Conclusion:
• Find your data collectors
• www.ncdr.com
• Set up a NCDR account
• Review the data elements and definitions
• Ask for outcomes