Clinical Registriesin Cardiac Surgery

Peter S. Greene, MDCMIO, Johns Hopkins Medicine

Diane AlejoInformation Systems Manager

Division of Cardiac Surgery

September 15, 2010ICTR Clinical Registry Workshop

Cardiac Surgery Database spans 1944 - 2010• Clinical and administrative data tracking• Supports IRB approved clinical research activities• Allows longitudinal outcome follow-up

STS Adult Cardiac Surgery Data / STS Congenital DataHeart and Heart- Lung Transplant DatabaseUNOS Registry ISHLT / INTERMACS VAD RegistryCollaborative Transplant Research Database

Cardiac Surgery Data Management

History of Cardiac Surgery Database

933 1944-1950 Blalock-Taussig Registry

15,010 1950-1982 Cardiac Registry - Medical Archive’s Operative Logs

7,738 1983-1994 Cardiac Surgery Database & Cardiac Transplant Database

18,934 1996-2010 Expanded Data Collection - Point of Care / Work Flow Integration

42, 615 Total Operations recorded in the Databases

STS Adult Cardiac Surgery Database Participation

> 13,000 Johns Hopkins Adult Cardiac Operations submitted to STS from 1997- 2010

Clinical Documentation

STS

LeapFrog

NQFPQRI

Performance Improvement

Payers

Research Patient Care

Billing AdminReports

DATA

UNOSResident Education

Maintenance of

Certification

DRG Codes

STS Participation

LeapFrog / PQRINational Quality Forum

Performance ImprovementScore Cards

Maintenance of CertificationSurgeon / Resident Portfolios

APRDRG codes

Payers , RFI / RFP’s

ICD 9 codes

CPT codes

Administrative ReportingBilling / Resource Utilization

Cardiac Database

Consumers & Marketing

Sources of Data and Reporting For Outcome Measurement & Research in Cardiac Surgery

ClinicalData

Clinical Registries

Research Data

REPORTS

1. Must have strong clinical leadership and pervasive buy-in2. Must integrate with clinical workflow3. Must provide net benefit to clinicians4. Must stay within scope of readily known data5. Must have a stable and capable clinical team 6. Must have a stable and capable data team7. Must audit for completeness8. Must give regular feedback9. Must pre-stage submissions

Some Lessons Learned

Outcome Data  

 

Standardized information on cardiac & thoracic surgical procedures

Data analyzed by separate, independent, objective data analysis center (DCRI)

Opportunities to improve patient care

# Participants # Records Harvest

Adult Cardiac 992 2.7+ million 4 times / year

General Thoracic 81 185,508 operations 2 times / year

Congenital 142 96,628 operations 2 times / year

STS National Database

STS Pilot Pay For Performance (P4P) Program

Incentive payments for achievement of thresholds in performance measures

A model of quality improvement with 3 types of measures:Structureal: IT, database participation, volumeProcess: IMA use, discharge beta blockersOutcomes: Mortality, Morbidity: CVA, renal failure

Blended STS NCD and financial (UB-92) database

NQF performance measures

2007 PQRI Initiative – CMS

New 2007 STS Composite Scoring System

STS National Database

DCRI – Data Warehouse and Analysis Center

Data transmitted electronically

National, Regional and “Like Institution” benchmarking

Reports include site specific, risk adjusted, regional and national aggregate date including morbidity, mortality and LOS for CABG, Valves and CABG/Valve surgery

Statistical Analysis – Risk Modeling- Logistic Regression, Hierarchical regression modeling

STS National Database

STS Auditing

Risk factor model variables

NQF measures

Op log procedures

Operative deaths and morbidity

STS National Database

STS Adult Database 992

STS Congenital Database 81

STS Thoracic Database 142

Total 1215

STS National DatabaseParticipation

STS Composite Quality ScoreDistribution of Participant Site Ratings

12

77

11

0

25

50

75

100

March 2008

Perc

ent

STS Composite Quality Ratings

* Participant is significantly lower than the STS mean * * Participant is not significantly different than the STS mean * * * Participant is significantly higher than the STS mean

Jan – Dec 2009

JHH STS Rating

Overall 95.3 % 95.3 %

Avoidance of Mortality

97.3 % 97.9 %

Avoidance of Morbidity

82.6 % 84.5 %

Use of IMA 98.5 % 94.5 %Medications 80.2 % 76.0 %

Research InformaticsDepartment of Surgery

PREMISES OF THIS PROPOSALFOR A SURGERY DATA CENTER

• Almost every faculty member and research trainee has a need for accessing clinical data for research purposes

• There is insufficient revenue to support a centralized research database– There is a modest amount of research database activity in the

department• There is an extensive amount of clinical information

within JHMI in an electronic format, but these exist in multiple sources

• There is an extensive amount of surgical patient data being collected and analyzed for non-research activities (e.g.: safety, accreditation, payers, training)

IDXSALAR

Lung Cancer Database (M. Brock)STS Thoracic Database

Transplant Information SystemsTeleresults

UNOS / CTRD

Maryland Trauma Registry

AnesthesiaADR

Specialty SurgicalResearch Databases

ORMIS

CasemixCVIEW Cardiac Surgery Database

STS Adult Cardiac / Congenital

SurgeryCore

ISHLT VAD Registry

Internal Data Sources and Internal Database Initiatives

ClinicalData

NSQIP

Research Data

EPR

POE

Tumor Registry

Departmental Prototype

Clinical Trial Databases

Idea – Explore Influence of Randomness

Idea – Quality Collaborative

Idea – Patient Registries

From Dr. Adrian PuttgenDept. Neurology, Critical Care

http://www.youtube.com/watch?v=WQ2PFoHptK8

1. Unique patient population2. Unique patient tracking capability3. Unique patient detail or comprehensiveness4. Unique patient data integration5. Regional quality programs6. National quality programs

Clinical Registry Opportunities