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ACTION Registry-GWTG New User Training
Webinar
February 7,2013
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
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
Data Collection OptionsWeb-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
www.ncdr.com Participant Log In
The ACTION Registry-GWTG Webpage
Call the American Hospital Association 1-800-424-4301
The Dashboard
Dashboard• eReports• Comparator
eReports
• Standard Reports• Executive
Summary Metrics• “Drill Downs”
Comparator
• Define peer groups
• Facility attribute filters
Technical Data Dictionary
Outcomes Report Companion Guide
Inclusion Population• Acute Myocardial Infarctions-STEMI & NSTEMI• Patient must present to 1st 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
Choosing the Correct Form
Premier Form or Limited FormEvery Hospital Has The Option
To Use Either Form
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
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
Limited Form: Pros and ConsPros
Fewer Data Elements
Less time required fordata abstraction and entry
Accommodating for NonPCI Centers
Great form for new sites to start
ConsNo Excessive dosingReports for Anticoagulants
Lower Level of Recognition
Limited Quarterly Outcomes Report Not all the metrics are included
Premier Form: Pros and ConsPros
Detailed Quarterly Excessive
Dosing Reports forAnticoagulants
Higher level of Recognition
Robust Data Set
Full Quarterly OutcomesReport
ConsMore time required for dataabstraction and entry
Answering fields that are less
likely to pertain to Non-PCICenters
Demographics
Cardiac Status & History
Medications
Anticoagulants
Procedures
Reperfusion Strategy
Clinical Events & Biomarkers
Labs
Discharge
Section K- Optional Elements
Data Quality Reports(DQR)
Data Assessment Results
Failed Completeness Assessment
ACTION Registry-GWTG
National Data Slide Sets Produced every 6 months
Use of Reperfusion Therapy for STEMISTEMIN = 21,978
ReperfusionN = 17,711 (81%)
No Reperfusion –No Contraindication ListedN = 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
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
6279
103
Q1 07
120
158
223
6078
102
Q2 07
116
151
215
5775
Q3 07
113
156
212
5774
95
Q4 07
Tim
e (m
in)
50
220210
60708090
110100
120130140150160170
200
180190
240230
96
403020
250
100
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
5267
84
Q2 08
96
120
157
5166
Q3 08
94
117
150
506479
Q4 08
Tim
e (m
in)
50
220210
60708090
110100
120130140150160170
200
180190
240230
82
403020
250
100
87%
20%
67%
0%
20%
40%
60%
80%
100%
DTB <= 90 min -Non-Transfer In
DTB <= 90 min -Transfer In
DTN <= 30 min - All
DTB = 1st Door to Balloon for Primary PCIDTN = 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
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
0%
5%
10%
15%
20%
25%
30%
Q3 2008 Q4 2008 Q1 2009 Q2 2009
UFH*LMWH#GP Iib-IIIa
Quarterly Outcomes Reports
Composite Measure
Composite MeasureOverall AMI Performance Graph
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
Performance Measure Graph: Aspirin at Arrival
Quality MetricsACTION Metrics
Door to EKG (within 10 min) STEMI- Acute ADP Receptor Inhibitor Therapy within 24 hours of
arrival_Revascularized Patients Discharged on ADP Receptor InhibitorsADP Receptor Inhibitors Prescribed at Discharge for Medically
Treated PatientsLDL assessment (in-hospital) NSTEMI - Excessive Initial UFH Dosing (>70 U/kg bolus, >15 U/kg/min
infusionExcessive 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)
ACTION Registry-GWTG Recognition Program
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
Recognition Thresholds
Award LevelsMust meet compliance on
composite measuresParticipate in
Platinum90% compliance
>= 8 consecutive quarters entering data
Premier
Gold90% compliance
>= 8 consecutive quarters entering data
Premier or Limited
Silver90% compliance
>= 4 consecutive quarters entering data
Premier or Limited
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,
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
