Overview of ACC`s National Cardiovascular Data Registry

National
Quality
Registry
Network
Webinar Series
#1
Kathleen Hewitt, MSN, RN, AACC, CPHQ
AVP, American College of Cardiology
©American College of Cardiology
- EHRs; meaningful use
- Public Reporting
- Value based purchasing
- Payment cuts
- Accountable Care
- Claims data profiling
Organizations
- Physician Quality Reporting System (PQRS)
- Episode
- Preauthorization - Payer Programs
groupers
- Efficiency metrics (= cut costs) - Hospital employment
- Bundled payments (capitation) - Coverage determinations
- Utilization review
- MOC / MOL
- Appropriateness auditing
- Certification exams
There’s a shift . . .
:
C MS
ICD y
istr
g
e
R
TVT y
istr
g
e
R
An Emerging Vision of Registries at the ACC
Gap
Analysis
Peerreviewed
Research
&
Guidelines
Registry
Data
Quality &
Performance
Improvement
Why we invest
Awareness
9Unique clinical information
9Enable performance measurement by physicians for physicians and hospitals
9Support for novel scientific research production
9Scaled delivery of registry‐
driven quality improvement programs
4
Can clinical registries help?
Clinical
Data
Bufalino VJ et al. Circulation. 2011;123:2167-2179
2500 hospitals
> 2000 cardiologists
20 million clinical records
PVI
1998
2004
2005
2006
2007
2008
2010
2012
Participants, Patient Records, Manuscripts & Abstracts
Name
CathPCI
(Diag. Cath &PCI)
ICD
ACTION Registry‐GWTG
(STEMI & NSTEMI)
CARE
(CAS & CEA)
IMPACT
(Adult & Ped Congenital Intervention)
PINNACLE
(All CV Outpatient)
STS/ACC TVT
(Transcatheter Valve Therapy)
# of Participants
# of Patient Records
1500
14.5 million
1600
900,000
800
465,000
180
15,000
70
2000
2000
6.7 million
165
1500
NCDR Governance
NCDR collaborations
Maintenance Of
Certification
Open-book
modules testing
clinical and
practical
knowledge in a
particular field.
NCDR 3rd Party Reporting Services
ent
Cons
ure
signat
How Registry Participation Works
One master
contract with
addendums for
each registry
(except TVT)
Many vendor
options and
NCDR offers
complimentary
web entry if
needed
Data Dictionary Alignment
Vendors creating
systems to avoid
redundant data
collection
• New definition and
technical alignment
• Launch late 2013
Data Quality Program…
• Training and Clinical
Support Team
–
–
–
–
–
–
Orientation webinars
Online FAQs
Live customer support
Email
Monthly webinars
Annual meeting with case reviews, etc.
• Data Entry Integrity
–
–
–
Value checks
Range checks
Parent:Child fields
• Data Quality Report
–
–
registry-specific algorithms
predetermined levels of completeness
and consistency required for data to be
included in national and comparison
group averages
• Data Audit Program
¾
300 to 625 records are audited
annually, within 25 randomly identified
sites.
In the 2010 audits, the overall
accuracy of data abstraction for
the CathPCI, ICD, and ACTIONGWTG registries were,
respectively, 93.1%, 91.2%, and
90.0%.
JACC June, 2012
Annual NCDR Conference
ACC.13 NCDR Session Series
NCDR Dashboard
•
•
•
•
•
Executive summary metrics
Performance measures
Trending graphs
Drill down to the patient level
Unique comparison group filters
Clinical data
Quality benchmarks
E-Report
Executive Summary
Detailed Graphs
1.
Proportion of patients that receive an ICD that meet class I guideline indications.
Comparison Groups
1. Participant
5. Comparison Group or
Volume Group
2. Reporting Timeframe
6. State\Province
3. Metric Prompt
7. No Of Certified Beds
4. Teaching Institution
New! Physician Level Dashboard
• Hospital Exec Summary metrics reported
at physician level
• Used for
a)
b)
c)
d)
Awareness
Motivation
Self directed PIM
Education with CME, MOC and possibly
MOL
Volume Summary
Different Perspectives
Public reporting….
STS and
Consumers
Union
Perspective: NEJM Oct 21, 2010
• ACC + SCAI + HRS + reporting partner
• Hospital level measures
• Voluntary reporting
2011
ACC Board motion
2012
2013-2014
Clinical registries provide a platform for phase 3 & 4 research
Pre-Market
Post-Market
Role for New Generation
of Clinical Registries
Phase 4
Phase 1
• Safety is
primary
endpoint
• Highly selected
population (must
meet several
selection
criteria)
• Short duration
Phase 2
• Safety and
efficacy are
primary
endpoints
• Highly
selected
population
• Short duration
Phase 3
• Safety and
efficacy are
primary endpoints
• Selected
population
• Pivotal studies
(randomized
controlled trial,
RCT)
• Longer duration
PostApproval
• FDA driven
and negotiated
• Centers
defined
• Generally a
Phase 3
continuance
• Sample size
pre-determined
• Study interval
defined
PostMarket
• Sponsor driven
• Generally RCT
or Claims based
• Direct product
comparisons
• Costs collected
• Sample size
pre-determined
• Study interval
defined
Traditional
Registries
• Product performance
and safety data
• Effectiveness is the
primary endpoint
• Hypothesis
generating
• Large and usually
undefined sample
size
• Real world
population
• Continuous duration
• Treatment not
assigned
Questions?