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ACTION Registry-GWTG New User Training Webinar February 7,2013.

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Presentation on theme: "ACTION Registry-GWTG New User Training Webinar February 7,2013."— Presentation transcript:

1 ACTION Registry-GWTG New User Training Webinar February 7,2013

2 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

3 The History: ACTION Registry- GWTG ACTION Registry transitioned from CRUSADE and NRMI Registries January 2007 ACTION was established May 2008 ACTION merged with AHA GWTG CAD to become ACTION Registry-GWTG Current membership of 800 Hospitals 500,000 records submitted

4 Data Collection Options Web-Based Data Capture –Secure, password-protected data entry system –Free NCDR data collection tool –Interoperability from Cath/PCI Registry to ACTION Vendor-Based Data Capture –Data submitted via encrypted, password-protected file –Interoperability between ACTION and Cath/PCI Registry

5 www.ncdr.com Participant Log In

6 The ACTION Registry-GWTG Webpage

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11 Call the American Hospital Association 1-800-424-4301

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14 The Dashboard Dashboard eReports Comparator eReports Standard Reports Executive Summary Metrics “Drill Downs” Comparator Define peer groups Facility attribute filters

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20 Technical Data Dictionary

21 Outcomes Report Companion Guide

22 Inclusion Population Acute Myocardial Infarctions-STEMI & NSTEMI 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 within 24 hours of arrival Transfer In patients- STEMI must arrive within 72 hours, NSTEMI within 24 hours If presents with any other symptoms, or procedures, the patient is excluded

23 Choosing the Correct Form Premier Form or Limited Form Every Hospital Has The Option To Use Either Form

24 ACTION Registry-GWTG Premier Form Complete quarterly Outcome Report for benchmarking –Report on 17 Core Performance Measures –Report on 12 Quality Metrics Sites are Eligible for Higher Level of Recognition Program

25 ACTION Registry-GWTG Limited Form 50% of full ACTION data set Limited quarterly Outcome Report for benchmarking –Report on 17 Core Performance Measures –Report on 7 Quality Metrics Lower level of Recognition

26 Limited Form: Pros and Cons Pros Fewer Data Elements Less time required for data abstraction and entry Accommodating for Non PCI Centers Great form for new sites to start Cons No Excessive dosing Reports for Anticoagulants Lower Level of Recognition Limited Quarterly Outcomes Report Not all the metrics are included

27 Premier Form: Pros and Cons Pros Detailed Quarterly Excessive Dosing Reports for Anticoagulants Higher level of Recognition Robust Data Set Full Quarterly Outcomes Report Cons More time required for data abstraction and entry Answering fields that are less likely to pertain to Non-PCI Centers

28 Demographics

29 Cardiac Status & History

30 Medications

31 Anticoagulants

32 Procedures

33 Reperfusion Strategy

34 Clinical Events & Biomarkers

35 Labs

36 Discharge

37 Section K- Optional Elements

38 Data Quality Reports (DQR)

39 A way of checking the quality of your data It looks for data errors and completeness Passing ensures well-formed data Data must pass DQR to be included in the Outcomes Report Submit as you enter data through the quarter

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41 Data Assessment Results

42 Failed Completeness Assessment

43 ACTION Registry-GWTG National Data Slide Sets Produced every 6 months

44 Use of Reperfusion Therapy for STEMI STEMI N = 21,978 Reperfusion N = 17,711 (81%) No Reperfusion – No Contraindication Listed N = 1272 (6%) Not Eligible for Reperfusion Therapy Contraindication Listed N= 2,866 (13%) Primary PCI – 86%* Fibrinolytics – 13%* Both PCI + Lytics – 1%* 93% of eligible patients reperfused * Among patients receiving reperfusion ACTION Registry-GWTG DATA: July 1, 2008 – June 30, 2009

45 ACTION Door-to-Balloon Times – Median Times for Transfer In and Non-Transfer In Patients Transfer in DTB TimesNon-Transfer in DTB Times 123 169 236 62 79 103 Q1 07 120 158 223 60 78 102 Q2 07 116 151 215 57 75 Q3 07 113 156 212 57 74 95 Q4 07 Time (min) 50 220 210 60 70 80 90 110 100 120 130 140 150 160 170 200 180 190 240 230 96 40 30 20 250 10 0

46 STEMI Door-to-Balloon Times – Median Times for Transfer In and Non-Transfer In Patients Transfer in DTB TimesNon-Transfer in DTB Times 102 130 182 53 70 88 Q1 08 97 123 165 52 67 84 Q2 08 96 120 157 51 66 Q3 08 94 117 150 50 64 79 Q4 08 Time (min) 50 220 210 60 70 80 90 110 100 120 130 140 150 160 170 200 180 190 240 230 82 40 30 20 250 10 0

47 DTB = 1 st Door to Balloon for Primary PCI DTN = Door to Needle for Lytics STEMI – Door to Balloon and Door to Needle Times: Cumulative 12 Month Data ACTION Registry-GWTG DATA: July 1,2008 – June 30, 2009

48 NSTEMI Acute Medication Overdosing Trends * Infusion (> 15 units/kg/hr) or bolus (> 70 units/kg) # Initial dose (> 1.05 mg/kg) or total 24 hr dose (> 10 mg over recommended) ACTION Registry-GWTG DATA: July 1, 2008 – June 30, 2009

49 Quarterly Outcomes Reports

50 Composite Measure

51 Overall AMI Performance Graph

52 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 Performance Measures

53 Performance Measure Graph: Aspirin at Arrival

54 Quality Metrics ACTION Metrics Door to EKG (within 10 min) STEMI- Acute ADP Receptor Inhibitor Therapy within 24 hours of arrival_ Revascularized 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 (SQ >1.05 mg/kg) Excessive Initial GP IIb/IIIa Dosing (Full doseTirofiban if CrCl<30& Full dose Eptifibatide CrCl <50, or dialysis with either) STEMI - Anticoagulant- UFH, enoxaparin, bivalarudin or fondaparinux (first 24 hours) Aldosterone Blocking Agents at Discharge(EF<40%, with DM, or HF)

55 ACTION Registry-GWTG Recognition Program

56 Recognition Criteria Patient Volume –10 NSTEMI within each quarter; and/or –10 STEMI within past quarter Must maintain uninterrupted data submission for Q1 – Q4 90% compliance

57 Recognition Thresholds Award Levels Must meet compliance on composite measures Participate in Platinum 90% compliance >= 8 consecutive quarters entering data Premier Gold 90% compliance >= 8 consecutive quarters entering data Premier or Limited Silver 90% compliance >= 4 consecutive quarters entering data Premier or Limited

58 Criteria for STEMI’s STEMI composite: –ASA on Arrival –DTN<=30 minutes –DTB<=90 minutes) –discharge ASA –discharge beta-blocker, –discharge ACE-I/ ARB (ideal patients) –discharge statin (exclude if contraindicated or LDL<100mg/dl and not discharged on statin) –smoking cessation counseling, –cardiac rehabilitation,

59 Criteria for NSTEMI’s NSTEMI composite: –ASA on Arrival –discharge ASA –discharge beta-blocker –discharge ACE-I/ ARB (ideal patients) –discharge statin (exclude if contraindicated or LDL<100mg/dl and not discharged on statin) –smoking cessation counseling –cardiac rehabilitation

60 (800) 257-4737 or email ncdr@acc.org Thank you for your participation in ACTION Registry-GWTG!


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