Institutional Outcomes Report 2012Q2 Sample Hospital

Transcription

1 Version 2.2 Institutional Outcomes Report 2012Q2 If User desires to publish or otherwise distribute or use, in whole or in part, any aggregate data or reports provided by ACCF, or produced in connection with or derived from NCDR, with the exception of strictly internal use within User's organization, User must first obtain the prior express written consent of ACCF. To the extent User is permitted to publish aggregate data, such aggregate data and any related information published in connection with it must be reviewed and approved by ACCF prior to publication. National Cardiovascular Data Registry ACTION Registry -GWTG

2 Table of Contents Inclusion Summary 3 Quarters included in this report: 3 group included in this report: 3 Release Notes: 3 Frequently used terminology: 4 Executive Summary 7 Section IA: Composite Measures 7 Section IIA: AMI Performance Measures 10 Section III: Quality Metrics 14 Section IV: Participant Graphs 16 Detail Section Line Reference 21 2

3 Inclusion Summary Quarters included in this report: Timeframe Benchmark Inclusion Status Submission Type All Patients STEMI NSTEMI Included in Executive Summary 2011Q3 Limited Yes 2011Q4 Limited Yes 2012Q1 Limited Yes 2012Q2 Limited Yes group included in this report: Group Group Name 2 No Cath Lab Services on-site, or only Diagnostic Catheterizations Number of Hospitals per Group 3 Diagnostic Caths and PCIs performed on-site Cardiac Surgery, to include Diagnostic Caths and PCIs, are performed on-site (Region 1) 5 Cardiac Surgery, to include Diagnostic Caths and PCIs, are performed on-site (Region 2) 6 Cardiac Surgery, to include Diagnostic Caths and PCIs, are performed on-site (Region 3) 7 Cardiac Surgery, to include Diagnostic Caths and PCIs, are performed on-site (Region 4) Your Hospital's Group 59 X Release Notes: ACTION Registry -GWTG Outcomes Report Release Notes for 2012 Q2 Report Changes: 1. Quality Metric 24, Detail Line The earliest date for all anticoagulants will be checked. Previously if UFH was outside of the first 24 hours it would exclude the record even if another anticoagulant was within the 24 hours. 2. Quality Metric 31, Detail Line The algorithm was changed to exclude patients with an LDL "Value Out of Range" selected. 3. Quality Metric 25, Detail Lines 1028, 1197, 1568, and The algorithm was changed to not evaluate Primary PCI for NSTEMI records. 4. Detail Lines 1375, 1741, An additional line was added to include the proportion of non-cabg related transfusions. 5. Detail Lines 1609 and No reason documented was removed from the algorithm for both Reason Thrombolytics not Administered and Reason Primary PCI not Performed. 6. Detail Lines 1376, 1742 and The denominator now includes only those patients that received a red blood cell infusion instead of those that had a red blood infusion and a CABG related transfusion. 7. Detail Lines 1264, 1268, 1272 and There is no check in the data collection tool to verify that if First ECG Obtained is Pre-Hospital or After 1st Hospital Arrival that the First ECG Date/Time is prior to or after Arrival Date/Time. If first ECG obtained pre hospital is selected however the First ECG Date/Time is after the Arrival Date/Time a negative number will be calculated. This can be corrected by changing the First ECG obtained to After 1st hospital arrival or changing First ECG Date/Time prior to Arrival Date/Time. 3

4 Inclusion Summary Frequently used terminology: (Rolling Four Quarters) Benchmark Inclusion Status The four (4) consecutive quarters included in this report. (Example: The 2011Q1 report includes 2010Q2, 2010Q3, 2010Q4 and 2011Q1. The Q in indicates the last quarter of the rolling four quarters). Indicates whether a submission will be included in the aggregated data (benchmark) and comparison group statistics. Green, Yellow and Red stoplights denote the status. A Green status indicates the submission (one quarter/timeframe) is included in the benchmark and comparison group statistics. The data has successfully passed all data assessment and completeness checks. A Yellow status indicates the submission (one quarter/timeframe) is not included in the benchmark and comparison group statistics. Data is displayed in the quarterly column, but is not included in the My Hospital summary. The data has not passed the overall completeness assessment checks. A Red status indicates the submission (one quarter/timeframe) is not included in the benchmark or comparison group statistics. Data is not displayed in the quarterly column. A null or blank status indicates no submission has been received for that quarter/timeframe. Data is not displayed in the quarterly column. Submission Type My Hospital Hospital 50th Pctl Hospital 90th Pctl Registry Pts Group 2 Indicates the Submission Type selected at the time of data export/submission. Limited submissions refer to the ACTION Registry GWTG Limited dataset. Premier submissions refer to the full ACTION dataset. The values for a metric/measure (over ) of data submitted by your facility with a Benchmark Inclusion Status of Green. The median (or midpoint or 50th percentile) of all participants aggregated data for the metric or measure. Half of all participants will be above the median, and half will be below. This value will correspond to the midpoint of the box/whisker plot with a Benchmark Inclusion Status of Green. The 90th percentile of all participants aggregated data for the metric or measure. 10% of all participants will be above the 90th percentile value, and 90% will be below. This value will correspond to the right-most endpoint of the box/whisker plot with a Benchmark Inclusion Status of Green. The aggregated value for the measure/metric across all patients (over ). To be included, data must have a Benchmark Inclusion Status of Green. ACTION-GWTG sites with same on-site cardiac facilities (cath lab and open-heart surgery) as your hospital, based on AHA-reported data. No Cardiac Services are performed at your facility, or only Diagnostic Catheterizations (No PCIs, or open-heart surgeries). Participants: Compared against all Participants where no cath lab services or Diagnostic cath (only) services are performed on-site. International Participants: Compared against all Participants where no cath lab services or Diagnostic cath (only) services are performed on-site. Indicator X is a representation of where your hospital would fall in the distribution. Group 3 Diagnostic Cath and PCIs performed on site. Adult Cardiac Interventions and diagnostic catheterizations are performed at your facility, but not open-heart surgery. Participants: Compared against all Participants where Diagnostic Cath and PCIs are performed on site. 4

5 Inclusion Summary International Participants: Compared against all Participants where Diagnostic Cath and PCIs are performed on site. Indicator X is a representation of where your hospital would fall in the distribution. Group 4 Diagnostic Cath, PCIs and Cardiac Surgery performed on site. All cardiac procedures are performed at your facility, to include diagnostic catheterizations, PCIs, and open-heart surgery. Participants: Compared against (Region 1) Participants where Diagnostic Cath, PCIs and Cardiac Surgery are performed on site. Region 1 includes facilities in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, and New Jersey. International Participants: Compared against all participants (not Region specific) where Diagnostic Cath, PCIs and Cardiac Surgery are performed on site. Indicator X in box-whisker is a representation of where your hospital would fall in the distribution. Group 5 Diagnostic Cath, PCIs and Cardiac Surgery performed on site. All cardiac procedures are performed at your facility, to include diagnostic catheterizations, PCIs, and open-heart surgery. Participants: Compared against (Region 2) Participants where Diagnostic Cath, PCIs and Cardiac Surgeries are performed on site. Region 2 includes facilities in Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Mississippi, Alabama, Oklahoma, Texas, Arkansas, and Louisiana. International Participants: Group 4 is not applicable. Group 6 Diagnostic Cath, PCIs and Cardiac Surgery performed on site. All cardiac procedures are performed at your facility, to include diagnostic catheterizations, PCIs, and open-heart surgery. Participants: Compared against (Region 3) Participants where Diagnostic Cath, PCIs and Cardiac Surgeries are performed on site. Region 3 includes facilities in Wisconsin, Michigan, Illinois, Indiana, Ohio, Missouri, North Dakota, South Dakota, Nebraska, Kansas, Minnesota, and Iowa International Participants: Group 5 is not applicable. Group 7 Diagnostic Cath, PCIs and Cardiac Surgery performed on site. All cardiac procedures are performed at your facility, to include diagnostic catheterizations, PCIs, and open-heart surgery. Participants: Compared against (Region 4) Participants where Diagnostic Cath, PCIs and Cardiac Surgeries are performed on site. Region 4 includes facilities in Idaho, Montana, Wyoming, Nevada, Utah, Colorado, Arizona, New Mexico, Alaska, Washington, Oregon, California, and Hawaii. International Participants: Group 6 is not applicable. Note: Where a facility is not included in any of the comparison groups, due to an unmatchable AHA number,no X will be displayed in the Your Hospital's Group column. 5

6 Inclusion Summary Box and Whisker Plots 6

7 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section IA: Composite Measures STEMI/NSTEMI Composite Measures 1 Overall AMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 94.3% 94.8% 98.9% Includes all 11 acute and discharge performance measures. Proportion of performance measure opportunities that were met among eligible opportunities. Distribution of Hospital Performance 10th percentile 90th percentile Better Measures include: Aspirin at Arrival Evaluation of LV Systolic Function Reperfusion Therapy (STEMI only) Time to Fibrinolytics (STEMI only) Time to Primary PCI (STEMI only) Aspirin at Discharge Beta Blocker at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral [Detail Line:1002] 2 Overall defect free care My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 69.7% 73.8% 93.5% The proportion of patients that receive "perfect care" based upon their eligibility for each performance measure. If a patient fails to receive even one therapy for which he or she is eligible, that patient fails to meet the "defect-free" criteria and will be removed from the numerator. That patient will still be included in the denominator however. [Detail Line:1003] 3 STEMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 96.6% 96.7% 99.6% Includes all 11 acute and discharge performance measures for STEMI patients. Proportion of performance measure opportunities that were met among eligible opportunities. Measures include: Aspirin at Arrival Evaluation of LV Systolic Function Reperfusion Therapy (STEMI only) Time to Fibrinolytics (STEMI only) Time to Primary PCI (STEMI only) Aspirin at Discharge Beta Blocker at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral [Detail Line:1004] 4 NSTEMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 92.3% 93.6% 98.7% Includes all 8 acute and discharge performance measures for NSTEMI patients. Proportion of performance measure opportunities that were met among eligible opporutnities. Measures include: Aspirin at Arrival Evaluation of LV Systolic Function Aspirin at Discharge Beta Blocker at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral [Detail Line:1005] 7

8 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section IA: Composite Measures 5 Acute AMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 97.9% 96.4% 99.3% Includes all 5 acute composite performance measures for all AMI patients. Proportion of AMI patients with perfect adherence to the performance measures among all eligible care opportunities for those patients. Measures include: Aspirin at Arrival Evaluation of LV Systolic Function Reperfusion Therapy (STEMI only) Time to Fibrinolytics (STEMI only) Time to Primary PCI (STEMI only) [Detail Line:1006] 6 Discharge AMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 91.8% 94.3% 99.2% Includes all 6 discharge performance measures for all AMI patients. Proportion of performance measure opportunities that were met among eligible opporutnities. Measures include: Aspirin at Discharge Beta Blocker at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral [Detail Line:1007] 8

9 Section IB: Composite Measures Graphs Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Overall AMI Performance Composite: 2011Q3-2012Q2 Overall Defect Free Care: 2011Q3-2012Q % 98.0% My Hospital Group Hospitals 90th = 99% 100.0% 90.0% My Hospital Group Hospitals 90th = 93% 96.0% 80.0% 94.0% 70.0% 92.0% 60.0% 90.0% 50.0% 88.0% 40.0% 86.0% 30.0% Hospital Score 87.6% 93.4% 94.7% 98.5% Hospital Score 35.5% 61.7% 73.2% 92.6% STEMI Performance Composite: 2011Q3-2012Q2 NSTEMI Performance Composite: 2011Q3-2012Q % 98.0% My Hospital Group Hospitals 90th = 100% 100.0% 98.0% My Hospital Group Hospitals 90th = 99% 96.0% 96.0% 94.0% 94.0% 92.0% 92.0% 90.0% 90.0% 88.0% 88.0% 86.0% Hospital Score 89.3% 96.5% 97.6% 98.5% Hospital Score 86.5% 92.1% 92.1% 98.5% Acute AMI Performance Composite: 2011Q3-2012Q2 Discharge AMI Performance Composite: 2011Q3-2012Q % 99.0% My Hospital Group Hospitals 90th = 99% 100.0% 98.0% My Hospital Group Hospitals 90th = 99% 98.0% 96.0% 97.0% 94.0% 92.0% 96.0% 90.0% 95.0% 88.0% 94.0% 86.0% 93.0% 84.0% Hospital Score 93.2% 97.3% 99.3% 99.3% Hospital Score 84.2% 90.9% 91.6% 97.9% 9

10 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section IIA: AMI Performance Measures Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, Ho PM, Kosiborod MN, Masoudi FM, Nallamothu BK. ACC/AHA 2008 performance measures for adults with ST-elevation and non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2008;52: STEMI/NSTEMI Performance Measures 7 Aspirin at arrival My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 97% 99.3% 100.0% Proportion of patients prescribed aspirin at arrival excluding patients transferred in and out. [Detail Line:1009] Distribution of Hospital Performance 10th percentile 90th percentile Better 8 Aspirin prescribed at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 99.3% 99.1% 100.0% Proportion of patients prescribed aspirin at discharge. [Detail Line:1010] 9 Beta-blocker prescribed at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 99.4% 97.9% 100.0% Proportion of patients prescribed a beta-blocker at discharge. [Detail Line: 1011] 10 Statin prescribed at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 100% 99.1% 100.0% Proportion of patients prescribed a statin at discharge. [Detail Line:1012] 11 Evaluation of LV systolic function My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 99.4% 96.1% 100.0% Proportion of patients evaluated for LV systolic function. [Detail Line:1013] 12 ACE-I or ARB for LVSD at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 85% 91.8% 100.0% Proportion of patients prescribed an ACE-I or ARB for LVSD at discharge. [Detail Line:1014] 13 Proportion of STEMI patients receiving fibrinolytics within 30 minutes My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 23.8% 100.0% Proportion of STEMI patients with a time from your hospital arrival (or subsequent ECG if ST elevation first noted on subsequent ECG) to fibrinolytics <= 30 minutes. [Detail Line:1015] 14 Median time in minutes to fibrinolytic therapy for STEMI patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl Your hospital's median time in minutes from hospital arrival to fibrinolytics for STEMI patients. [Detail Line:1016] 10

11 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section IIA: AMI Performance Measures Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, Ho PM, Kosiborod MN, Masoudi FM, Nallamothu BK. ACC/AHA 2008 performance measures for adults with ST-elevation and non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2008;52: Proportion of STEMI patients receiving primary PCI within 90 minutes My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 93.7% 96.1% 100.0% Proportion of STEMI patients with a time from your hospital arrival (or subsequent ECG if ST elevation first noted on subsequent ECG) to primary PCI <= 90 minutes. [Detail Line:1017] 16 Median Time in minutes to primary PCI for STEMI patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl Your hospital's median time in minutes from hospital arrival to primary PCI for STEMI patients. [Detail Line:1018] 17 Reperfusion therapy My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 100% 98.8% 100.0% Proportion of STEMI patients that received either fibrinolytics or a primary PCI. [Detail Line:1019] 18 Time in minutes from ED arrival at STEMI referral facility to ED discharge from STEMI referral facility in patients transferred for PCI (1) My Hospital Hospitals 50th Pctl Hospitals 90th Pctl Your hospital's median time in minutes from ED arrival at referral facility to ED discharge at referral facility among patients transferred for a primary PCI. [Detail Line:1020] Low Volume Alert 19 Time in minutes from ED arrival at STEMI referral facility to Primary PCI at STEMI receiving facility among transferred patients (1) My Hospital Hospitals 50th Pctl Hospitals 90th Pctl Your hospital's median time in minutes from arrival at STEMI referring facility to primary PCI at STEMI receiving facility among patients transferred for a primary PCI. [Detail Line:1021] Low Volume Alert 20 Adult smoking cessation advice counseling My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 100% 100.0% 100.0% Proportion of patients that received smoking cessation advice/counseling among those that have smoked within the past year. [Detail Line:1022] 21 Cardiac rehabilitation patient referral from an inpatient setting My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 67.1% 84.1% 99.2% Proportion of patients that received a cardiac rehab referral. [Detail Line: 1023] Executive Summary Footnotes 1 IMPORTANT INTERPRETATION NOTE: Median times by quarter are plotted in the graph, thus downward slope indicates improvement as shorter times are preferable 11

12 Section IIB: AMI Performance Measures Graphs Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Aspirin at Arrival: 2011Q3-2012Q2 Aspirin at Discharge: 2011Q3-2012Q % 98.0% My Hospital Group Hospitals 90th = 100% 100.0% 99.5% My Hospital Group Hospitals 90th = 100% 99.0% 96.0% 98.5% 94.0% 98.0% 92.0% 97.5% 97.0% 90.0% 96.5% 88.0% 96.0% Hospital Score 89.7% 97.9% 97.9% 100.0% Hospital Score 96.4% 100.0% 100.0% 100.0% Beta Blocker at Discharge: 2011Q3-2012Q2 Statin at Discharge: 2011Q3-2012Q % 99.5% 99.0% My Hospital Group Hospitals 90th = 100% 100.0% 98.0% My Hospital Group Hospitals 90th = 100% 98.5% 96.0% 98.0% 97.5% 94.0% 97.0% 92.0% 96.5% 96.0% 90.0% Hospital Score 96.4% 100.0% 100.0% 100.0% Hospital Score 100.0% 100.0% 100.0% 100.0% Evaluation of LV Systolic Function: 2011Q3-2012Q2 ACE-I or ARB for LVSD at Discharge: 2011Q3-2012Q % 99.0% My Hospital Group Hospitals 90th = 100% 100.0% 96.0% My Hospital Group Hospitals 90th = 100% 92.0% 98.0% 88.0% 97.0% 84.0% 96.0% 80.0% 95.0% 76.0% Hospital Score 100.0% 97.7% 100.0% 100.0% Hospital Score 100.0% 85.7% 77.8% 100.0% 12

13 Section IIB: AMI Performance Measures Graphs Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Time to Fibrinolytics <= 30 mins (STEMI): 2011Q3-2012Q2 Time to Primary PCI <= 90 mins (STEMI): 2011Q3-2012Q % 90.0% 80.0% My Hospital Group Hospitals 90th = 100% 100.0% 96.0% 92.0% My Hospital Group Hospitals 90th = 100% 70.0% 60.0% 88.0% 84.0% 80.0% 50.0% 76.0% 40.0% 72.0% 30.0% 68.0% Hospital Score Hospital Score 71.4% 90.9% 100.0% 96.0% Reperfusion Therapy (STEMI): 2011Q3-2012Q2 Door in to Door Out (STEMI): 2011Q3-2012Q % 98.0% 96.0% 94.0% 92.0% My Hospital Group Hospitals 90th = 100% Median Time in Mins My Hospital Group Hospitals 90th = % 24 Hospital Score 100.0% 100.0% 100.0% 100.0% Hospital Score Door in to PCI (STEMI): 2011Q3-2012Q2 Adult Smoking Cessation Advice: 2011Q3-2012Q2 Median Time in Mins My Hospital Group Hospitals 90th = % 98.0% 96.0% 94.0% 92.0% My Hospital Group Hospitals 90th = 100% % Hospital Score Hospital Score 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% Hospital Score Cardiac Rehab. Referral: 2011Q3-2012Q2 37.9% 65.1% 65.9% 90.5% My Hospital Group Hospitals 90th = 99% 13

14 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section III: Quality Metrics Quality Metrics 22 Door to 1st ECG in minutes My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 64.1% 65.0% 83.9% Proportion of AMI patients that received an ECG within 10 minute of arrival at participating hospital. [Detail Line:1025] Distribution of Hospital Performance 10th percentile 90th percentile Better 23 Acute ADP receptor inhibitor therapy among STEMI patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 100% 94.8% 100.0% Proportion of STEMI patients prescribed ADP Receptor Inhibitors 24 hours prior to or after 1st hospital arrival. [Detail Line:1026] 24 Acute anticoagulant agent for NSTEMI My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 94.2% 100.0% Proportion of NSTEMI patients prescribed unfractionated heparin, enoxaparin, bivalirudin or fondaparinux 24 hours prior to or after 1st hospital arrival. [Detail Line:1027] 25 Excessive initial unfractionated heparin (UFH) dose My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 61.7% 12.8% Proportion of AMI patients that received: -An initial bolus dose of UFH >70 units per kilogram OR -A total initial bolus dose exceeding 4000 units OR -An initial infusion > 15 units per kilogram per hour OR -A total initial infusion >1000 units per hour. [Detail Line:1028] 26 Excessive initial enoxaparin dose My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 9.4% 0.0% Proportion of AMI patients that received an initial dose of subcutaneous Enoxaparin >1.05 mg per kilogram. [Detail Line:1029] 27 Excessive initial GPIIb-IIIa inhibitor therapy My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 6.2% 0.0% Proportion of AMI patients that received GPIIb-IIIa (Full dose of Tirofiban if CrCL <30 cc/min and/or dialysis = yes or full dose of Eptifibatide if CrCL <50 cc//min and /or dialysis = yes) [Detail Line:1030] 28 AMI revascularized patients discharged on ADP receptor inhibitors My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 91.1% 93.5% 100.0% Proportion of AMI revascularized patients prescribed an ADP receptor inhibitor at discharge. [Detail Line:1031] 29 ADP receptor inhibitors prescribed at discharge for medically treated AMI patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 59.1% 55.5% 80.0% Proportion of AMI medically treated patients prescribed an ADP receptor inhibitor at discharge. [Detail Line:1032] 30 Aldosterone blocking agents for LVSD at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 0% 7.8% 37.8% Proportion of AMI patients prescribed an aldosterone blocking agent at discharge. [Detail Line:1033] 14

15 Section III: Quality Metrics Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 31 LDL-Cholesterol assessment My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 67.7% 85.0% 95.7% Proportion of patients that had an LDL-Cholesterol assessment. [Detail Line: 1034] 32 Aspirin at arrival for all patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 97.8% 99.1% 100.0% Proportion of patients that received an aspirin on arrival. [Detail Line:1035] 15

16 Section IV: Participant Graphs Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Site Admission Trend Admission Trend 45 STEMI NSTEMI 25,000 STEMI NSTEMI ,000 Admissions Admissions 15,000 10, , Distribution of Patient Age Distribution of Race and Gender 32.0% 28.0% 29% 26% Hospital 60.0% 50.0% 56% Hospital Percent of Admissions 24.0% 20.0% 16.0% 12.0% 8.0% 4.0% 3% 7% 18% 18% 10% 12% 6% 10% 12% 9% 22% 17% Percent of Admissions 40.0% 30.0% 20.0% 10.0% 43% 17% 9% 28% 29% 11% 6% 0.0% >= % Male/White Male/Non White Female/White Female/Non White 80.0% 76.0% ECG w/in 10 Minutes of Presentation 75% Hospital Time from Symptom Onset to Hospital Presentation 2.01 Hospital Percent of Admissions 72.0% 68.0% 64.0% 60.0% 56.0% 52.0% 70% 68% 57% 56% 67% 54% Median Hours Time from Hospital Presentation to ECG 8.00 Hospital 48.0% 44.0% 40.0% 45% Male Female <75 years 75+ years Median Minutes 16

17 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Acute Medications (w/in 24h of Hospital Presentation) In-Hospital Procedures 100.0% 97% 98% Hospital 90.0% 80.0% 82% 86% Hospital 80.0% 70.0% 65% 65% Percent of Admissions 60.0% 40.0% 55% 54% 34% Percent of Admissions 60.0% 50.0% 40.0% 30.0% 20.0% 20.0% 10% 10.0% 6% 9% 0.0% Aspirin Clopidogrel GP IIb/IIIa 0.0% Diag Cor Angio PCI CABG Drug Eluting vs Bare Metal Stents Reperfusion Use 75.0% 70.0% 71% 69% Hospital 102.0% 100.0% 100% Hospital 65.0% 98.0% 97% 97% Percent of Admissions 60.0% 55.0% 50.0% 45.0% 40.0% Percent of Admissions 96.0% 94.0% 92.0% 90.0% 88.0% 35.0% 30.0% 29% 32% 86.0% 84.0% 84% 85% 84% 25.0% DES Bare Metal 82.0% Reperfusion Transfers in Non-Transfers in 80.0% 70.0% 60.0% In-Hospital Antithrombin Medications 70% 61% Hospital Percent of Admissions 50.0% 40.0% 30.0% 39% 51% 32% 33% 20.0% 10.0% 0.0% 7% 0% 0% 1% UFH LMWH Fondaparinux DTI Thrombolytics 17

18 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 First Medical Contact to ECG to Hospital Arrival to Needle (Pre-Hospital ECG) FMC to ECG ECG to arrival Arrival to needle First Medical Contact to Hospital Arrival to ECG to Needle (ECG After Hospital Arrival) FMC to arrival Arrival to ECG ECG to needle Minutes Minutes First Medical Contact to ECG to Hospital Arrival to Balloon (Pre-Hospital ECG) FMC to ECG ECG to arrival Arrival to balloon First Medical Contact to Hospital Arrival to ECG to Balloon (ECG After Hospital Arrival) FMC to arrival Arrival to ECG ECG to balloon Hospital Hospital Minutes Minutes 18

19 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 80.0% 70.0% 60.0% 74% Early Catheterization by Subgroups 74% 70% 67% 64% 74% Hospital Cath Time from Hospital Presentation to Procedure 3.5 Hospital Percent of Admissions 50.0% 40.0% 30.0% PCI % 10.0% CABG % 0% 0% 0% 0% 0% 0% Male Female <75 years 75+ years <50 cc/min 50+ cc/min Median Hours 8.0% 7.0% In-hospital Clinical Events 7% Hospital Overall Length of Stay Hospital 6.0% Percent of Admissions 5.0% 4.0% 3.0% 3% 4% Early Cath Any PCI % 1.0% 0.0% 2% 1% 1% 1% 0% Reinfarction Shock CVA/Stroke Death 10.0 Any CABG Median Days 19

20 Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Bleeding Events Among Subgroups Dosing Errors Percent of Admissions 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 3% 1% 4% 1% 3% 4% 5% 1% 3% Hospital Percent of Admissions 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 48% 12% 7% Hospital 0.0% 0% 0% 0% Male Female <75 years 75+ years <50 cc/min 50+ cc/min 0.0% UFH (AMI) Enox (AMI) GP IIb/IIIa (AMI) Discharge Medications Discharge Medications Percent of Admissions 105.0% 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 99% 98% 99% 97% Hospital Percent of Admissions 120.0% 100.0% 80.0% 60.0% 40.0% 76% 73% 85% 89% 100% 99% Hospital 65.0% 60.0% 55.0% 63% 62% Aspirin Clopidogrel Beta Blocker 20.0% 0.0% 0% 11% ACE/ARB Overall ACE/ARB Ideal Statin Other Lipid Lowering 20

21 Detail Section Line Reference Population Section First Line # Last Line # Executive Summary Detail Lines All Patients Submission Summary Demographics and Payors Medical History/Home Medications Hospital Presentation Acute and In-Hospital Medications and Dosing Errors In-Hospital Procedures Reperfusion Use Early Invasive Management Laboratory Results In-Hospital Events Bleeding Events Discharge Therapies Length of stay STEMI Patients Demographics and Payors Medical History/Home Medications Hospital Presentation Acute and In-Hospital Medications and Dosing Errors In-Hospital Procedures Reperfusion Use Early Invasive Management Laboratory Results In-Hospital Events Bleeding Events Discharge Therapies NSTEMI Patients Demographics and Payors Medical History/Home Medications Hospital Presentation Acute and In-Hospital Medications and Dosing Errors In-Hospital Procedures Reperfusion Use Early Invasive Management Laboratory Results In-Hospital Events Bleeding Events Discharge Therapies Overall AMI Subgroups Acute Therapies by Race Discharge Therapies by Race Acute and Discharge Therapies by Gender Acute and Discharge Therapies by Age Acute and Discharge Therapies by Transfer Status Acute and Discharge Therapies by Diabetes Status Acute and Discharge Therapies by Creatinine Clearance

22 Executive Summary Detail Lines My Hospital Registry Pts 1000 Executive Summary Detail Lines 1001 Composites 1002 Overall AMI Performance Composite ,098 1, , , Overall Defect Free Care , , STEMI Performance Composite , , NSTEMI Performance Composite 1006 Acute AMI Performance Composite 1007 Discharge AMI Performance Composite 1008 Performance measures , , , , , , Aspirin at arrival , , Aspirin prescribed at discharge , , Beta-blocker prescribed at discharge , , Statin prescribed at discharge , , Evaluation of LV systolic function 1014 ACEI or ARB for LVSD at Discharge , , , , Time to Fibrinolytic Therapy Median time to fibrinolytic therapy Time to primary PCI , , Median time to primary PCI Reperfusion therapy , , Median time to Door in door out transfer in patients (1) 1021 Median time to Door to balloon transfer in patients (1) 1022 Adult smoking cessation advice counseling 1023 Cardiac rehabilitation patient referral from an inpatient setting 1024 Quality metrics , , , , Door to 1st ECG , , Acute ADP receptor inhibitor , ,

23 Executive Summary Detail Lines My Hospital Registry Pts therapy among STEMI patients 1027 Acute anticoagulant agent for NSTEMI 1028 Excessive initial unfractionated heparin (UFH) dose 1029 Excessive initial enoxaparin dose 1030 Excessive initial GPIIb-IIIa inhibitor therapy 1031 AMI revascularized patients discharged on ADP receptor inhibitors 1032 ADP receptor inhibitors prescribed at discharge for medically treated AMI patients 1033 Aldosterone blocking agents for LVSD at discharge 3, , , , , , , , , , , LDL-cholesterol assessment , , Aspirin at arrival for all patients , ,

24 All Patients Submission Summary My Hospital Registry Pts 1036 Submission summary 1037 Total # of pt admissions , , STEMI , , NSTEMI , , Transfers in , , Not Transferred in , , Transfers out , Not transferred out , ,

25 All Patients Demographics and Payors My Hospital Registry Pts 1044 Demographics 1045 Sex 1046 Male , , Female , , Age at admission 1049 Mean age Median age , , , , , , , , , , , >= , , Medicare age ( >= 65) , , Race 1060 White , , Black/African American , Asian , American Indian/Alaskan Hawaiian/Pacific Islander Male/White , , Male/Non White , , Female/White , , Female/Non White , Hispanic or Latino Ethnicity , , Insurance payors 1071 Private , , Medicare , , Medicaid , , Military , State-specific (non-medicaid) , Indian Health Service Non-U.S Insurance None , ,

26 All Patients Medical History/Home Medications My Hospital Registry Pts 1079 History and risk factors 1080 Current smoker (< 1 year) , , Hypertension , , Dyslipidemia 6, , Currently on dialysis , Chronic lung disease 1, , Diabetes mellitus , , Diabetes therapy: 1087 None , Diet , Oral , , Insulin , , Other Obesity (BMI >= 30) 3, , Prior MI 2, , Prior heart failure 1, , Prior PCI 2, , Prior CABG 1, , Atrial fibrillation or flutter (past 2 weeks) , Cerebrovascular disease , , Prior stroke , Peripheral arterial disease , , Home medications 1102 Aspirin 4, , Clopidogrel 1, , Ticlopidine Prasugrel , Warfarin , Beta blocker 3, , ACE inhibitor 2, , Angiotensin receptor blocker 1, , Aldosterone blocking agent , Statin 3, , Non-statin lipid-lowering agent ,

27 All Patients Hospital Presentation My Hospital Registry Pts 1113 Hospital presentation 1114 Means of transport (first facility) 1115 Self/family , , Ambulance , , Mobile ICU Air Means of transfer (outside facility) 1120 Ambulance , , Mobile ICU , Air , , Location of first evaluation 1124 ED 7, , Median hours from arrival to transfer out from ED Cath lab , Other 1, , First ECG obtained 1129 Pre hospital (3) , , After 1st hospital arrival , , Median time to 1st ECG (in min) 1132 ECG <= 10 min of presentation 1133 STEMI ECG findings , , ST elevation , , LBBB , Isolated posterior MI STEMI first noted 1138 First ECG , , Subsequent ECG , Other ECG findings 1141 New or presumed new ST depression 1142 New or presumed new T-wave inversion 1143 Transient ST elevation lasting <20 min , , , , ,

28 All Patients Hospital Presentation My Hospital Registry Pts 1144 None , , Median time from symptom onset to presentation (hours) (2) >= 6 hours , , < 6 hours , , Cardiac status on first medical contact 1149 Heart failure , , Cardiogenic shock , Hypotension , Tachycardia , , Cocaine use , Cardiac arrest , Pre-hospital , Outside facility ,

29 All Patients Acute and In-Hospital Medications and Dosing Errors My Hospital Registry Pts 1157 Acute and in-hospital medications and dosing errors 1158 Any acute oral antiplatelet , , Aspirin , , Clopidogrel , , Ticlopidine Prasugrel , , Beta blocker , , ACE inhibitor 3, , Angiotensin receptor blocker , Aldosterone blocking agent , Statin 6, , Non-statin lipid-lowering agent , GP IIb/IIIa inhibitor , , Eptifibatide , , Full dose 1, , Reduced dose , Other , Tirofiban Full dose Reduced dose Other Abciximab , Any GP IIb-IIIa inhibitor among PCI patients , , Started infusion pre-pci (4) , Started infusion peri-pci (5) , , Anticoagulant , , IV unfractionated heparin , , LMWH , , Enoxaparin , , Initial IV bolus , SubQ doses 1188 q 12 hours , q 24 hours ,

30 All Patients Acute and In-Hospital Medications and Dosing Errors My Hospital Registry Pts 1190 Dalteparin , Fondaparinux Direct thrombin inhibitors , , Bivalirudin , , Argatroban Lepirudin Dosing errors for anticoagulants and GP IIb- IIIa inhibitors 1197 Heparin, IV UFH-overall (all AMI) 1, , Bolus , Infusion , Enoxaparin-overall 1201 Initial Dose > 1.05 mg/kg , GP IIb-IIIa Inhibitor (All AMI) ,

31 All Patients In-Hospital Procedures My Hospital Registry Pts 1203 In-hospital procedures 1204 Non-invasive stress test , Diagnostic coronary angiography 1206 Cath without prior noninvasive stress testing 1207 Diagnostic cath results 1208 Non-obstructive CAD - all vessels <50% 1209 Pt with no CAD (all native vessels <=10% stenosis) (w/o CABG) 1210 Diseased vessels (including LM disease) , , , , , , LM disease (>=50%) , LM and RCA disease (triple vessel) 1213 LM w/out RCA disease (double vessel) 1214 Diseased vessel w/or w/o LM , , Single vessel disease 3, , Double vessel disease 2, , Triple vessel disease 1, , LV function 1219 Normal (EF >=50%) , , Mildly reduced (EF 40-49%) , , Moderately reduced (EF 25-39%) , , Severely reduced (EF <25%) , Not Assessed , Revascularization status (6) 1225 PCI , , Stent type 1227 Bare metal stent , , Drug eluting stent , , Other CABG , , No revascularization , ,

32 All Patients Reperfusion Use My Hospital Registry Pts 1232 Reperfusion use 1233 Reperfusion candidates , , Transfers , , Non-transfers , , Reason contraindication to reperfusion 1237 Primary reason for no reperfusion 1238 Reason primary PCI not performed 1239 Reason thrombolytics not administered 1240 Reperfusion candidate, but no PCI or thrombolytics , , , , Any thrombolytics , D2B for non transfers < =90 mins , , Median time (minutes) D2B for Transfers < = 90 mins , Median time (minutes) <= 120 minutes , Excluded from D2B non transfer and D2B transfers 1248 Door to needle (thrombolytics) <= 30 min Median (minutes) Non-system reason for delay Door in door out transfer in patients , Median (minutes) PCI Indications 1254 PCI for STEMI , , Immediate, primary PCI for STEMI , , Rescue PCI , Median time (minutes) Stable, successful reperfusion for STEMI or completed infarction post STEMI ,