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