2013, American Heart Association

Transcription

1 2013, American Heart Association

2 Mission: Lifeline - Data, Reports and ACTION Registry - GWTG THE MISSION: BETTER HEART ATTACK CARE FOR YOUR COMMUNITY THE LIFELINE: THE AMERICAN HEART ASSOCIATION AND YOU GAPS IN THE CARE SYSTEM COST LIVES - Each year, more than a hundred thousand ST-elevation myocardial infarction(stemi) patients fail to receive the best available treatment to restore blood flow to the heart muscle. - The American Heart Association created Mission: Lifeline as a response to missed opportunities caused by gaps in systems of care.

3 Presenters Lori Hollowell, BSN National Quality Systems Consultant Mission: Lifeline, ACTION Registry - GWTG American Heart Association Susan Rogers, BSN, MSN, NE-BC Director ACTION Registry - Get With The Guidelines American College of Cardiology Kevin I Daniel, RN, CEN Cardiovascular Data Specialist Quality Improvement Northside Hospital System, Atlanta, GA Chris Bjerke, BSN, MBA National Director- Mission: Lifeline American Heart Association 1/17/ , American Heart Association 3

4 Outline HOW TO USE ACTION REGISTRY- GWTG FOR QUALITY IMPROVEMENT I. ACTION Registry- GWTG Dashboard Reports: i. High profile data elements ii. Removing obstacles & improving outcomes II. Data output from the Premier versus Limited forms III. Using Mission: Lifeline Reports to Improve Outcomes i. Receiving Center / Regional Report Tools ii. Common questions on report interpretation III. Demonstration of data extract process IV. Multidisciplinary quality improvement: i. What disciplines are included in this team? ii. How often do you meet? V. How are the reports used to improve quality within your multidisciplinary team? What about improving quality within your system? VI. Are there data measures that are more frequent barriers to quality improvement? 1/17/ , American Heart Association 4

5 ACTION Registry -GWTG January 2013

6 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

7 Inclusion Population Acute Myocardial Infarctions-STEMI & NSTEMI only Patient must present to 1 st 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 the patient presents with any other symptoms, or procedures, the patient is excluded

8 Performance Measures 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

9 Door to EKG (within 10 min) Quality Metrics STEMI- Acute ADP Receptor Inhibitor Therapy Vascularized Patients Discharged on ADP Receptor Inhibitors ADP Receptor Inhibitors Prescribed at Discharge for medically treated patients LDL assessment (in-hospital) NSTEMI - Excessive Initial UFH Dosing (>70 U/kg bolus, >15 U/kg/min infusion) Excessive Initial Enoxaparin Dosing Excessive Initial GP IIb/IIIa Dosing STEMI - Anticoagulant- UFH, enoxaparin, bivalarudin or fondaparinux Aldosterone Blocking Agents at Discharge

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11 ACTION Registry-GWTG Limited 50% of full AR-G data set Limited quarterly Outcome Report for benchmarking Report on 17 Core Performance Measures Report on 7 Quality Metrics

12 What the Limited form does not give you Quality Metrics not included 1. NSTEMI - Excessive Initial UFH Dosing (>70 U/kg bolus, >15 U/kg/min infusion 2. Excessive Initial Enoxaparin Dosing (SQ >1.05 mg/kg) 3. Excessive Initial GP IIb/IIIa Dosing (Full dose Tirofiban if CrCl<30& Full dose Eptifibatide CrCl <50, or dialysis with either) 4. STEMI - Anticoagulant- UFH, enoxaparin, bivalarudin or fondaparinux (first 24 hours)

13 Comprehensive Outcome Reports Comparison Groups Quarterly Real Time reports Benchmarks Performance measures & metrics Hospital experience Like facility National experience Registry Dashboard Drill Downs Unique compare groups ACTION Registry-GWTG 2012

14 How Does The Dashboard Work? Dashboard ereports Comparator ereports Standard Reports Executive Summary Metrics Drill Downs Comparator Define peer groups Facility attribute filters

15 Look How We Compare! Select Filter Criteria Run Analysis Compare / View Trends

16 H_7KYi Filter Criteria

17 Comparator analysis My Hospital R4Q 6 Quarter Trend

18 Mission: Lifeline Reports 1/17/ , American Heart Association 18

19 Companion Guides Mission: Lifeline Regional Hospital Report Glossary Mission: Lifeline Regional Hospital Report Interpretation Manual 1/17/ AHA Mission: Lifeline 19

20 Collect and Report Your Data 1/17/ AHA Mission: Lifeline 20

21 Mission: Lifeline Regional Reports Current Regional Reports - 18 Regional Reports Unique Hospitals Participating A group of hospitals looking at data from a regional perspective to improve the STEMI System of Care 1/17/ AHA Mission: Lifeline 21

22 What is the difference between a dash ( - ) and a 0%? A hyphen (-) Indicates no patient opportunities for that particular line item Will not adversely affect recognition efforts A 0% means there were patients eligible and no patients met the criteria for that line item May adversely affect recognition efforts 1/17/ AHA Mission: Lifeline 22

23 Records with Null values are included in the denominator in the Mission: Lifeline reports. 10 STEMI Patients are entered for Q All 10 are eligible to receive acute ASA (Seq ) All 10 patients were actually given ASA within first 24 hours of admission Per data entry, 7 of these 10 = Acute ASA = YES 3 of these patients have NO value entered was left blank Performance Score Reflected for Acute ASA: 70% 7 Documented as Administered / 10 Eligible 70% - Not Eligible for Mission: Lifeline Recognition 1/17/ AHA Mission: Lifeline 23

24 Why is our hospital is missing some data in the Mission: Lifeline report? Highlighted Area = Elements NOT available in the Limited Form Mission: Lifeline Receiving Hospital Report Glossary 1/17/ AHA Mission: Lifeline 24

25 Limited Form v Premier Form Data Limited Users Premier Users 25

26 The Limited form does not allow a primary reason to support why a patient is not a reperfusion candidate AR-G Premier Form Highlights Not included in Limited Form Mission: Lifeline Report Adjustments When 8000 = NO Patient record is EXCLUDED For BOTH Limited and Premier Form Users 1/17/ AHA Mission: Lifeline 26

27 Mission: Lifeline Reperfusion Therapy Measure score differs between the 2 reports (M:L and Outcomes) Mission: Lifeline uses Seq 7109 to identify primary PCI patients 1/17/ AHA Mission: Lifeline 27

28 First Medical Contact Mission: Lifeline Measure: Mission: Lifeline First Medical Contact to Primary PCI 90 Minutes Variable (%) All STEMI admissions who receive a primary PCI within 90 minutes from first medical contact prior to arrival at the Receiving Center. Pre-Arrival 1 st Med Contact Date/Time = Eye to Eye contact between the STEMI patient and the 1 st Medical provider to deliver (ACS) Acute Coronary Syndrome care 12 Lead ECG Aspirin Administration Nitroglycerine Administration 1/17/ AHA Mission: Lifeline 28

29 First Medical Contact to PCI < 90 Minutes Measure What patients are included? 1/17/ AHA Mission: Lifeline 29

30 First Medical Contact to PCI < 90 Minutes Measure: What patients are NOT included? 1/17/ AHA Mission: Lifeline 30

31 2013 Mission: Lifeline Recognition FEBRUARY th Q Data Deadline DQR = Green 2012 data updates for Q1,2,and 3 1/17/ AHA Mission: Lifeline 31

32 1/17/ , American Heart Association 32

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34 Can you tell us how you have been able to partner with your EMS agencies?

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36 FirstFacMeansTrans FirstMedConTi StemiNot me FirstECGObtained FirstECGTime ed ECGFindings ASA_First24Start FirstDevActiTi Time me PCIDelayReason ICD9PrinDiag Ambulance 2:26:00 After First Hospital Arrival 3:12:00 No 4:35:00 14:20:00 Ambulance 15:47:00 After First Hospital Arrival 18:26:00 No 20:40:00 Lumpkin Ambulance 6:31:00 After First Hospital Arrival 6:31:00 Yes ST Elevation 6:39:00 Ambulance 9:20:00 After First Hospital Arrival 9:59:00 Yes ST Elevation 15:38:00 10:42:00 None Advanced Ambulance 0:13:00 After First Hospital Arrival 0:34:00 Yes ST Elevation 0:35:00 1:13:00 None Advanced Ambulance 12:57:00 After First Hospital Arrival 13:26:00 No 13:45:00 Advanced Ambulance 2:11:00 Pre-Hospital 2:26:00 No 2:15:00 12:09:00 Lumpkin Ambulance 3:20:00 Pre-Hospital 3:28:00 Yes ST Elevation 3:24:00 5:05:00 None Ambulance 2:54:00 Pre-Hospital 3:19:00 Yes ST Elevation 3:05:00 4:50:00 None Ambulance 22:02:00 Pre-Hospital 22:15:00 Yes ST Elevation 22:17:00 23:29:00 None Ambulance 13:55:00 Pre-Hospital 14:11:00 Yes ST Elevation 14:08:00 15:27:00 None Ambulance 20:22:00 Pre-Hospital 20:35:00 Yes ST Elevation 21:20:00 21:31:00 None Forsyth Ambulance 0:18:00 Pre-Hospital 0:29:00 Yes ST Elevation 0:29:00 1:51:00 None Dawson Ambulance 7:55:00 Pre-Hospital 8:05:00 Yes ST Elevation 8:05:00 9:07:00 None Advanced Ambulance 14:36:00 Pre-Hospital 14:36:00 Yes ST Elevation 14:40:00 15:14:00 None Advanced Ambulance 20:44:00 Pre-Hospital 20:59:00 No 20:49:00 Ambulance 16:37:00 Pre-Hospital 16:47:00 No 16:49:00 Advanced

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38 How do you use the dashboard reports to provide real-time feedback? Can you explain how you use the sort function? How do you address data entry errors once they are identified?

39 STEMI/ NSTEMI Aspirin Evaluation of LV Reperfusion Systolic Function Therapy (STEMI only) Time to Primary PCI (STEMI only) Aspirin at Beta Blocker Discharge at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral STEMI Yes Yes Yes Yes Yes Yes Yes Yes Yes STEMI Yes Yes Yes STEMI Yes Yes Yes Yes Yes Yes STEMI No Yes STEMI Yes Yes Yes Yes Yes Yes Yes Yes Yes STEMI Yes Yes Yes Yes Yes Yes Yes STEMI Yes Yes Yes Yes Yes Yes Yes Yes STEMI Yes Yes Yes Yes Yes Yes Yes Yes Yes STEMI Yes Yes Yes Yes Yes Yes STEMI Yes Yes Yes No Yes Yes Yes Yes

40 Are there any data measures that are barriers to quality Improvement?

41 FirstFacMeansTrans FirstMedConTime OnsetTime FirstECGObtained StemiNoted Physician1 Physician2 Ambulance 9:20:00 7:00:00 After First Hospital Arrival Yes Smith Self/Family 2:55:00 After First Hospital Arrival Yes Smith Ambulance 0:18:00 22:52:00 Pre-Hospital Yes Jones Ambulance 0:13:00 21:32:00 After First Hospital Arrival Yes Miller Adams Self/Family 18:23:00 After First Hospital Arrival Yes Adams Ambulance 7:55:00 7:23:00 Pre-Hospital Yes Miller Ambulance 14:36:00 13:50:00 Pre-Hospital Yes Jones Self/Family 7:00:00 After First Hospital Arrival Yes Jones Self/Family 10:45:00 After First Hospital Arrival Yes Smith Jones Self/Family 10:45:00 After First Hospital Arrival No Miller Ambulance 12:57:00 14:20:00 After First Hospital Arrival No Adams Ambulance 20:44:00 20:24:00 Pre-Hospital No Adams Self/Family 12:25:00 After First Hospital Arrival No Miller Adams Self/Family 18:54:00 After First Hospital Arrival No Jones Self/Family 2:30:00 After First Hospital Arrival No Adams Jones Self/Family 12:35:00 After First Hospital Arrival No Miller Ambulance 16:37:00 16:12:00 Pre-Hospital No Miller Self/Family 22:40:00 After First Hospital Arrival Yes Smith

42 Additional Questions? 1/17/ , American Heart Association 42