project fact sheet - Duke Clinical Research Institute

Regional Systems Accelerator
Implementation of The American Heart Association’s Mission: Lifeline
AMI Discharge and Follow-Up Demonstration Project.
Grant Quick Fasts for AHA Affiliate Systems & Quality Teams
Duke and AHA to develop FAQs as received and posted.
A. Program Description
This educational CME/JA program is intended to extend the guidelines for STEMI care through
the implementation of regional protocols for emergency cardiovascular care &
Mission: Lifeline principles of process improvement at a regional level. The demonstration
project for this Accelerator grant will be to extend best practice to the patient discharge planning
and patient teaching and implement a model to be evaluated by AMI readmission rate within 30
days and F/U at 3 months, 6 months, and 1 year for medication adherence.
1. Program Goals and Objectives
a. Regional Program Objectives
The regional leadership and regional participants should be able to do following:
1. Build on the “Regional Systems of Care Demonstration Project: Mission:
Lifeline ™ STEMI Systems ACCELERATOR and local consensus to create regional
response to STEMI emergency care in a timely, coordinated and consistent manner
including first EMS or transferring hospital patient contact to device of 90 or 120 minutes
respectively for ≥75% of patients in 14 regions in the United States.
2. Establish regional leadership in emergency cardiac care that includes passionate
and respected thought leaders to include physicians and administrators representing
hospitals emergency medicine, cardiology, and EMS. The leaders would build
consensus regarding regional solutions to coordinated care and form a regional
executive leadership team.
3. Implement, monitor, and maintain the intervention through partnerships*
between local stakeholder organizations, regional AHA leadership, and national experts.
* Physician Leader(s) of hospitals, EMS agencies, and regions may establish these
partnerships through a memorandum of cooperation (MOC) between individual
institutions, agencies, and systems to create regional quality improvement teams.
b. AMI Discharge and Follow Up Demonstration Project Goal
1. Examine 30-day readmission and one year treatment adherence through efficient
data feedback strategies may include, but are not limited to: Qualtrics hospital follow up;
State QIO data; Center for Medicare and Medicaid Services (CMS) readmission
identification (through ENCLAVE Virtual Research Data Center); and Surescripts network.*
*A subset of regions and subset of hospitals will take part in the demonstration project. It
will encompass discharge training and education modalities as well as adherence
monitoring through follow up. All regional hospital participants will be assessed on
readmission rates.
B. Project Timeline
C. Program Metrics / Targets
1. % of all primary PCI centers (where STEMI data will be extracted for direct and transferin populations) that have regional enrollment in ACTION Registry-GWTG for a minimum
of STEMI only & the limited version. Target: ≥75%.
2. First Medical Contact (FMC) to 1st Device time interval for direct cases. Track at 25th50th-75th percentile. Target: ≥75% cases within 90 minutes.
3. First Medical Contact (FMC) to 1st Device time interval for indirect cases. Track door in
– door out and FMC to 1st device time intervals at 25th-50th-75th percentile. Target:
≥75% cases with DIDO within 30 minutes; ≥75% cases with FMC to 1st device times
within 120 minutes; Applies to individuals, hospitals, and to regions.
4. Show positive improvement trends in regional performance for:
a. Key process and clinical outcomes (i.e., in-hospital mortality)
b. Monitoring for 30 day readmission
c. Evaluation of adherence to medications at 3 & 6 months follow-up
.
5. Outcomes will be measured for this program and a specific timeline for measurement will
be utilized.
D. Baseline Assessment July- December 2015
1. PCI Hospital & regional survey assessment for current practices in relation to STEMI
care.
2. Process outcomes to be collected at hospital and regional level.
3. FMC-1st device direct and transfer-in proportion to guideline goal by median and 25th50th-75th percentiles.
4. ED Time (Direct PCI Door of ED to Cath Lab Door and First Door in and ED out times for
transfer-in) both at hospital and regional level.
5. Clinical Outcomes at the Regional Level (in-hospital mortality) improvement from
baseline and compared to national ML data cohort.
6. 30-day readmission data for baseline quarters.
E. Quarterly Assessments
Oct-Dec 2015; Jan-March 2016; April-June 2016; July-Sept 2016; Oct-Dec 2016
1. Process outcomes to be collected at hospital and regional level.
2. FMC-1st device direct and transfer-in proportion to guideline goal by median, 25th-50th75th percentiles.
3. ED Time (Direct PCI Door of ED to Cath Lab Door and First Door in and ED out times for
transfer-in) both at hospital and regional level.
4. Comparing quarterly data to other Accelerator regions and nationally.
5. Alpha blinded individual hospitals compared to others in region on key process data.
6. Ongoing from discharge 3 & 6 month Follow Up and at 1 year for medication adherence.
F. Final Quarter
1. PCI Hospital & regional survey assessment for adoption of final practices in relation to
STEMI care and 30-day readmission data for baseline.
2. Process outcomes to be collected at hospital and regional level.
3. FMC-1st device direct and transfer-in proportion to guideline goal by median, 25th-50th75th percentile.
4. ED Time (Direct PCI Door of ED to Cath Lab Door and First Door in and ED out times for
transfer-in) both at hospital and regional level.
5. Clinical Outcomes at the Regional Level (in-hospital mortality) improvement from
baseline and compared to national ML data cohort.
6. 30-day readmission data for QI quarters and final.
7. Ongoing from discharge 3 & 6 month Follow Up and at 1 year for medication adherence
G. Grant Quick Facts
1. This is an educational outcomes grant for CME. CME will be awarded through Joint
Accreditation - for entire healthcare team & maintenance of certification for MDs).
2. The total budget for acute and discharge phase is a little over $5 million for 14
regions. To date, we have an LOA for $3.5 million from AstraZeneca as an educational
grant. Grant to be administered by Duke School of Medicine and School of Nursing. An
additional $250,000 has been raised and other grants are out and TBD. Additional
grants may be for CME or research.
3. The AHA will work as partners and drive several of the grant deliverables, as well as
working in tandem with Duke’s deliverables. The LOI between Duke and the AHA is
signed and an exact Scope of Work for the grant contract will be completed and
executed, hopefully by the new fiscal year.
4. The timeline is tight which means we will need to move fast. The AHA Affiliate and Duke
Systems team will circulate the grant regional application to appropriate regional
leadership in geographies with needs for improvement in systems of care for STEMI.
These needs include but are not limited to:
a. New or evolving regional systems. Will consider returning Accelerator regions
that have the potential to fully achieve national goals. The exact number of
regions will be determined by budget constraints of the regional systems grant,
AHA’s current/ongoing or projected ML plans at the affiliate level, and
determined synergy with the AHA GTO grant.
b. Strong preference for moderate to large MSA population (preferably in the top
50-75 MSAs in the US),
c. Lack of a regional system meeting national standards,
d. A high STEMI or CV mortality, or region needs for process or clinical outcomes
improvement
e. Region assessed as having key local leadership engaged,
f. EMS equipped and trained for STEMI response (training may be variable),
g. At least some level of existing participation in ACTION Registry-GWTG
h. Primary PCI Cardiac Service Line administrators in agreement to explore and
support regionalization.
i. All locations within the proposed region should be within reasonable driving
distance logical meeting place to ensure entire group attends and participates in
frequent regional meetings and subgroups (typically less than 2 hours round
trip).
j. The regional Mission: Lifeline Director engages no more than 3-5 health systems
(primary PCI hospitals number may vary) and associated non-PCI hospitals and
EMS agencies.
5. Learnings from our original Accelerator Demonstration Study need to be taken into
account & guide us on the design of our refined regional intervention.
6. Roles and responsibilities will need to be determined and placed in a business
agreement with a scope of work for Duke and AHA.
7. Unlike the last grant, we have considerable funding for the AHA 2016 fiscal year. Some
affiliates already have partial funding or like kind $$ for ML. This can now be
complemented and leveraged. The possibilities are open.
8. The grant funds for the AHA are primarily designed to support either a partially dedicated
or full time FTE for Regional ML System Implementation. Dedicated affiliate staff budget
is a total of $1,275,000.00. We have money dedicated for supplementing regional AR-G
participation and AR-G ACC Report charges and fees, Web EX Education and QI con
calls, and designated money for the Discharge Planning Hospital Stipend. Specifics to
be determined.
9. The remainder of the grant funds are for a small support staff at national center and in
service lines of the project (legal coordination and contracts, liaison between Duke and
AHA) the National Joint Accredited (JA) ERCV Care meeting –May 15-16, 2015, in
Charlotte, NC, regional Joint Accredited Launch Meetings, faculty and mentoringcoaching of local regional executive leadership teams for the course of the project, QI
improvement project management, research costs of the acute phase and the
demonstration project research design, implementation and evaluation.
10. Duke/AHA/Grant Executive Team will review the applications and select the regions for
acute intervention.
11. A Duke- AHA think tank will design, implement, and evaluate the discharge and follow
up Demonstration project. Affiliate staff will be briefed by May on this output and roles
and responsibilities.
12. The application supplies the necessary information for submission.
13. Application Deadline March 31, 2015.
14. The grant pays for the EMS Regional Leadership Team participant to travel to ERCV
Care, one air/drive mileage fare, and one room night in Charlotte for 10 regions.