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ACTION Registry-GWTG  New User Training Webinar ACTION Registry-GWTG  New User Training Webinar

ACTION Registry-GWTG New User Training Webinar - PowerPoint Presentation

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ACTION Registry-GWTG New User Training Webinar - PPT Presentation

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

action data stemi registry data action registry stemi gwtg discharge patients report transfer times pci form door quality reperfusion

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Slide1

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 WebpageSlide7
Slide8
Slide9
Slide10
Slide11

Call the American Hospital Association

1-800-424-4301Slide12
Slide13
Slide14

The DashboardSlide15
Slide16
Slide17
Slide18
Slide19
Slide20

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 quarterSlide40
Slide41

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!