February 72013 Purpose of ACTION RegistryGWTG National surveillance system for highrisk AMI patients admitted with STEMINSTEMI Assess characteristics treatments and outcomes of this patient population ID: 682896
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ACTION Registry-GWTG
New User Training Webinar
February 7,2013Slide2
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 methodsSlide3
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 submittedSlide4
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 Slide5
www.ncdr.com
Participant Log InSlide6
The ACTION Registry-GWTG WebpageSlide7Slide8Slide9Slide10Slide11
Call the American Hospital Association
1-800-424-4301Slide12Slide13Slide14
The DashboardSlide15Slide16Slide17Slide18Slide19Slide20
Technical Data Dictionary Slide21
Outcomes Report Companion GuideSlide22
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 excludedSlide23
Choosing the Correct Form
Premier Form or Limited Form
Every Hospital Has The Option To Use Either FormSlide24
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 ProgramSlide25
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 RecognitionSlide26
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 includedSlide27
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
CentersSlide28
Demographics Slide29
Cardiac Status & HistorySlide30
MedicationsSlide31
AnticoagulantsSlide32
ProceduresSlide33
Reperfusion StrategySlide34
Clinical Events & BiomarkersSlide35
LabsSlide36
DischargeSlide37
Section K- Optional ElementsSlide38
Data Quality Reports
(DQR)Slide39
Data Quality Reports (DQR)
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 quarterSlide40Slide41
Data Assessment ResultsSlide42
Failed Completeness AssessmentSlide43
ACTION Registry-GWTG
National Data Slide Sets
Produced every 6 monthsSlide44
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, 2009Slide45
ACTION Door-to-Balloon Times –
Median Times for Transfer In and Non-Transfer In Patients
Transfer in DTB Times
Non-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
0Slide46
STEMI Door-to-Balloon Times –
Median Times for Transfer In and Non-Transfer In Patients
Transfer in DTB Times
Non-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
0Slide47
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, 2009Slide48
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, 2009Slide49
Quarterly Outcomes ReportsSlide50
Composite MeasureSlide51
Composite Measure
Overall AMI Performance GraphSlide52
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 MeasuresSlide53
Performance Measure Graph:
Aspirin at ArrivalSlide54
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)Slide55
ACTION Registry-GWTG Recognition ProgramSlide56
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 Slide57
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 LimitedSlide58
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, Slide59
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 Slide60
(800) 257-4737 or email ncdr@acc.org
Thank you for your participation in
ACTION Registry-GWTG!