The ACC National Cardiovascular

Data Registry(NCDR)

Quality Management

Opportunities within the

Cardiac Cath Lab

Brenda Springer, RN BSN

Database Specialist

• Parkview Health Systems

• Sixteen plus years of Cath Lab Experience

• Four years Critical Care Experience

• Managing the Cath/PCI Database since its

inception, 2002

The ACC National Cardiovascular Data

Registry(NCDR)

I have nothing to disclose

Goals for today

• Raise awareness of the what the Cath/PCI

Registry can do for cardiologist practicing in

the cath lab

• Promote communications between data

abstractors and cardiologist

History of the ACC NCDR Cath/PCI

Registry

• Oldest of the six ACC NCDR registries--launched 1997

• Voluntary

• Comprehensive measurement system of data elements and standarized definitions

• Focus on quality in the Cath Lab

• Over 1046 sites enrolled. With 856 sites submitting data

• Over Two million Cath/PCI records

• Multi-phased audit program

• PCI Mortality is Risk Adjusted

• 192 Data Fields for PCI Registry version three

• Version four will have 254 beginning July 1,2009

• Parkview has 13,876 patient records and growing everyday

NCDR Registries

• Care Registry (Carotid Artery

Revascularization and Endarterectomy

Registry

• ICD Registry

• ACTION Registry—GWTG

• IC3 (Improving Continuous Cardiac Care)

• IMPACT Registry (Improving Pediatric and

Adult Congenital Treatment)

How data is collected and distributed at

Parkview

• Interface from HIS to Cath Lab Hemo System

to Cath/PCI software

• Chart Audits

• All demographics are interfaced

• Five fields for patient history are interfaced

• Small amount of “Intra” Cath Lab data is also

interfaced

What can be obtained from this

database?

• Physician Specific Reports

• Hospital Specific Reports

• Door to Balloon Times

• Data Cleansing

Cath/PCI Information Output

• Sample of reports created exclusively through

the Cath/PCI software

• Sample of reports created using the quarterly

ACC NCDR reports

ST Elevated MI(STEMI) Non-Transfers

Arrival to Parkview Randallia

Reported in minutes

79

75

77

82

70

72

74

76

78

80

82

Parkview 79 75 77 82

2007Q3 2007Q4 2008Q1 2008Q2

Primary PCI for STEMI

Indicate whether the PCI procedure is being performed for purposes of

reperfusion in the presence of an acute MI documented in the medical record.

Percentage of total PCI Patients

18.5%

15.3%

17.8%

19.2%

17.7%

14.9%

12.9%

0.0%

5.0%

10.0%

15.0%

20.0%

Parkview 18.5% 15.3% 17.8% 19.2% 17.7%

Like Hospitals 14.9%

All Hospitals 12.9%

2007Q2 2007Q3 2007Q4 2008Q1 R4Q

Average Fluoro Exposure per Interventional MD

PCI Procedures

Quarter Two 2008

14.2

13.112.5

11.3

8.1

11.3

12.3

8.17.8

9.810.3

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Minutes

Average Fluoro Time 14.2 13.1 12.5 11.3 8.1 11.3 12.3 8.1 7.8 9.8 10.3

1 2 3 4 5 6 7 8 9 10 11

Average Contrast Use per Interventionalist

2008 Quarter Two

237

12

171

5

156

41

227

9

201

22

204

25

186

7

172

15

277

26

146

19

237

41

0

50

100

150

200

250

300

1 2 3 4 5 6 7 8 9 10 11

Pink denotes average contrast use

Orange denotes number of PCI procedures

Average Door to Balloon Time per Interventionalist

2008 Quarter Two

(Reflected in Minutes)

83

65

82

0

104

50

77 79

71

92

99

0

20

40

60

80

100

120

1 2 3 4 5 6 7 8 9 10 11

“0” refers to NO STEMI cases performed in this quarter.

Risk Adjusted Mortality Rate

All PCI Patients

(line 1736)

0.00%

0.50%

1.00%

1.50%

Parkview 1.29% 0.85% 0.89% 1.29% 1.12%

Like Hospitals 1.25%

All Hospitals 1.22%

2007Q2 2007Q3 2007Q4 2008Q1 R4Q

American College of Cardiology(ACC) National Cardiovascular Data

Registry(NCDR)

Cath/PCI Data Base

Survival Rates

98.2%

98.4%

98.6%

98.8%

99.0%

99.2%

Parkview Hospitals 98.9% 99.0% 98.5% 99.1%

Like Hospitals 98.8% 98.8% 99.0% 98.9%

All Hospitals 98.9% 98.8% 99.0% 99.0%

2008Q1 2007 2006 2005

Angiographic Success for Acute PCI (STEMI only)

(Calculated per Lesion Success)

(line 1870)

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

Parkview 94.9% 98.3% 94.7% 97.0% 96.1%

Like Hospitals 94.7%

All Hospitals 94.9%

2007Q2 2007Q3 2007Q4 2008Q1 R4Q

PCI Procedures with Primary PCI

Successful Primary PCI Rate

(line 1886)

80.0%

85.0%

90.0%

95.0%

100.0%

Parkview 90.7% 91.4% 88.1% 97.6% 91.9%

Like Hospitals 88.6%

All Hospitals 88.7%

2007Q2 2007Q3 2007Q4 2008Q1 R4Q

Aspirin on discharge

All PCI Patients with ACS

(line 1581)

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

Parkview 98.9% 100.0% 99.4% 98.8% 99.3%

Like Hospitals 96.3%

All Hospitals 96.7%

2007Q2 2007Q3 2007Q4 2008Q1 R4Q

Beta Blocker on discharge

Among Patients with STEMI

All PCI Patients

(line 1585)

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

Parkview 100.0% 100.0% 100.0% 100.0% 100.0%

Like Hospitals 94.3%

All Hospital 94.3%

2007Q2 2007Q3 2007Q4 2008Q1 R4Q

ACE Inhibitor/ARB on discharge

Among Patients with EF <=40%

All PCI Patients

(line 1583)

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Parkview 91.2% 93.1% 86.4% 93.5% 90.6%

Like Hospitals 76.5%

All Hospitals 78.0%

2007Q2 2007Q3 2007Q4 2008Q1 R4Q

Conclusion:

• Find your data collectors

• www.ncdr.com

• Set up a NCDR account

• Review the data elements and definitions

• Ask for outcomes