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NCDR Update
Board of Governors
Meeting
September 16, 2007
John Brush, MD, FACC
Chair, Quality Strategic Directions Committee
ACC Governor, Virginia Chapter
20 Years of Performance Measurement
1987
1997
Hospitals
2007
Physicians
HCFA CCP Pilot
JCAHO
ORYX
IOM Rpt
CED
IOM Rpt
HCFA hospital mortality reports
AQA
Healthgrades Leapfrog
JCAHO “Agenda for Change”
QPM to CMS
HCFA HCQII
HCFA National CCP
NQF
IOM Rpt
QPM to JCAHO
JCAHO Core Pilot
PQRI
HCFA 6 Nat’l Conditions
NCQA HEDIS measures
NCQA website
JCAHO Core
Measures
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QCARE
ACC’s Commitment To You
•
•
•
•
Continuous review of new science
Evidence-based guidelines and standards
Comprehensive education
Data reporting and collection through registries
(NCDR)
• National Quality Initiatives (D2B)
• Adoption and appropriate use of new technology
• Evaluation through self-assessment tools,
performance testing and longitudinal studies
3
QCARE
Evaluation
Technology
Science
Patient
Centered
Standards
Care
Quality
Initiatives
Education
Reporting
4
Imaging
CHD
ICD
Long
ICD
Registry
CARE
Registry
ACTION
Registry
IC3 CAD
Office
Ped.
Registry
EP
Registry
PracMgt
Registry
PAD
Registry
HF
Registry
CathPCI
Registry
1997….. 2004
2005
2006
2007
2008
beyond
5
Partners
CathPCI
• Society for Cardiovascular Angiography and
Intervention
ICD
• Heart Rhythm Society
CARE
• Society for Cardiovascular Angiography and
Intervention
• Society for Interventional Radiology
• American Academy of Neurology
• American Academy of Neurosurgery
• Society of Vascular Medicine and Biology
ACTION
• In discussion with American Heart Association
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CathPCI Registry Enrollment
1000
1000
900
825
800
700
Facilities
Registry/QI
• >950 hospitals
• 6 million patient
records
• Online data entry tool
launch 4/07
• Support D2B Alliance
ARS
• States – MA, OH, WV,
?CT, ?NJ
• Payers – United,
BCBSA, WellPoint
Research and
Publications
• DCRI analytic center
• 8* abstracts at AHA
658
600
500
472
400
300
200
272
321
547
362
190
100
0
1999
2000
2001
2002
2003 2004
Participants
2005
2006
2007F
7
ICD Registry Enrollmennt
1600
1400
1324 1338 1350
1200
1154
1206
1450
1420 1438 1442
1243
1000
Facilities
Registry
• 1450 enrolled
• 150,000 patient records
Funding
• 2007 support from WellPoint
• $1,895/year
ARS
• UHC added ICD Registry
participation for sites with EP
Labs
• Discussions underway with
BCBSA
• Provide data to CMS for
reimbursement
Research
• ICD Longitudinal Study
• Performing analysis for FDA
800
746
600
400
325
200
110
0
2/1/2006
4/1/2006
6/1/2006
8/1/2006
Participants
10/1/2006
12/1/2006
2/107
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CARE Registry Participationt
250
235
198
200
Facilities
Registry
• 235 Participants
• Data entry tool
• $3195.00/year
ARS
• CMS required
Research
• Performing analysis
for FDA
• Discussion with
CAS makers re:
PMS
154
150
100
50
0
8
13
25
42 45
57
74
87
98
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug07
07
07
07
07
07
07
07
06
06
06
06
Participants
9
Registry
• 250+ participants
• No charge
• Funding provided
by
ARS
• Early discussions
with payers
200
Facilities
– Genentech
– Bristol-Myers
Squibb/Sanofi
Partnership
– Schering Plough
Corporation
250
ACTION Registry Participationt
150
100
50
0
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Participant
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NCDR CathPCI
% Patients with D2B Time
90 min
120 min
150 min
20
04
Q
2
20
04
Q
3
20
04
Q
4
20
05
Q
1
20
05
Q
2
20
05
Q
3
20
05
Q
4
20
06
Q
1
20
06
Q
2
20
06
Q
3
20
06
Q
4
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Timeframe
Data Source: NCDR CathPCI Database, 2004Q2 - 2006Q4
Percentage of Primary PCI with D2B <= 90 minutes
NCDR CathPCI v3
80%
70%
50%
40%
30%
D2B
20%
10%
0%
20
04
Q
3
20
04
Q
4
20
05
Q
1
20
05
Q
2
20
05
Q
3
20
05
Q
4
20
06
Q
1
20
06
Q
2
20
06
Q
3
20
06
Q
4
20
07
Q
1
20
07
Q
2
Percentage
60%
Tim efram e
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PCI Statins on Discharge
86.0%
84.0%
82.0%
80.0%
78.0%
76.0%
74.0%
20
05
Q
4
20
06
Q
1
20
06
Q
2
20
06
Q
3
20
06
Q
4
20
07
Q
1
20
04
Q
3
20
04
Q
4
20
05
Q
1
20
05
Q
2
20
05
Q
3
72.0%
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ACTION Registry™
(Acute Coronary Treatment and Intervention Outcomes
Network)
Initial Report
1st Quarter 2007 Results
2006-07 Data Submission Summary
Admission
Timeframe
# of
# of
Sites
NSTEMI Records
# of
STEMI
Records
ACTION
Jan. 1, 2007 –
Mar. 31, 2007
227
6,917
CRUSADE
April 1, 2006 –
Dec. 31, 2006
280
20,084
4,259
4,391
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ACTION Registry 2007 Patient
Enrollment
5000
Number of Patients
enrolled
4169
4241
4154
Apr-07
May-07
4004
3787
4000
3000
2000
1000
0
Jan-07
Feb-07
Mar-07
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NSTEMI Patient - Baseline
Characteristics
NSTEMI
Variable (n = 26,902)
Mean age ± SD (yrs)
69 ± 14
Female
40%
Diabetes mellitus
33%
Prior MI
29%
Prior CHF
16%
Prior PCI
23%
Prior CABG
19%
ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902)
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In-Hospital Outcomes
Variable
NSTEMI
(n = 26,902)
Death
Re-infarction
CHF
Cardiogenic Shock
Stroke
RBC Transfusion*
3.8%
1.5%
6.8%
2.4%
0.7%
8.9%
*Excluding CABG patients
ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902)
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NSTEMI Acute Medications
100%
97%
93%
85%
80%
60%
60%
53%
40%
20%
0%
ASA
Beta
Blockers
Heparin
(LMW+UHF)
GP llb-llla
Inhibitors
Clopidogrel
ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007
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NSTEMI Discharge Medications
100%
96%
95%
% Use
80%
91%
74%
73%
60%
40%
20%
0%
ASA
B-Blocker
ACE-I or ARB*
*LVEF < 40%, CHF, DM, HTN
# Known hyperlipidemia, TC, LDL
ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n= 26,902)
Lipid Lowering
Agent#
Clopidogrel
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New Hospital-Based Registries
CathLab
Congenital Heart Disease Registry
• Transcatheter device occlusion of CV
malformations
– Atrial Septal Defect
– Ventricular Septal Defect
– Patent Ductus Arteriosus
– Fistula/Collateral Vessels—Blood Vessel
Communication
– Closure of Fontan Fenestration
• Transcatheter Balloon Dilation
• Transcatheter Stent Placement
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Pilot Study
Evaluation of
Appropriateness of
SPECT MPI
The American College of Cardiology
The American Society of Nuclear Cardiology
SPECT MPI Registry Objectives
• Evaluate appropriateness
• Promote awareness of appropriateness
criteria in practice
• Provide feedback reports to improve both
practice-level and individual physicianlevel adherence to the criteria
• Establish benchmarks to guide
performance improvement
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NCDR QI
• National QI Programs
NCDR & D2B
Take ACTION
Field Consultants
– Implement guidelines
recommendations
– Improve physician adherence
– Improve patient compliance
• Our Goal?
– Reduce complications
– Improve Structure and
Process
– Efficient Systems
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“Take ACTION” Campaign
• Nationwide QI Program
– Increase awareness about relevant CPG recommended therapies
for ACS and chronic stable coronary disease
– Improve physician adherence and patient compliance
• Long-term Goal
– Reduce secondary events post ACS
– Measured incrementally through behavioral changes
• Multiple, overlapping Phases beginning ACC.07
– Phase I - What is the ACC doing to Take ACTION to
improve care of patients with ACS?
– Phase II - What are you doing as a physician to Take
ACTION?
– Phase III - What are you doing as patients to Take
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ACTION?
Improving Continuous Cardiac
Care
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Measuring the Continuum of
CAD
Care
AMI Care
Patient with
Onset of Acute
stable angina Coronary Syndrome
Post-Hospitalization:
Risk factor modification
D/C Cardiac rehabilitation
Admit PCI/CABG
IC3
ACTION
ACCNCDR
IC3
ACTION
Follow-up
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The IC3 Program
• First office-based registry designed to
assess physician adherence to
ACC/AHA Performance Measures.
• Provides a powerful tool to assess the
current state of office-based clinical
care for CAD and CHF patients.
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Philosophy of the IC3 Program
• Make it easier for busy clinicians to do the right thing
for the right patient at the right time
– Track key performance measures for CAD/CHF
• Internal QI and P4P reporting at the practice
level
• Performance measures for DM also captured
– Make care more efficient
• A worksheet that readily identifies opportunities
to apply CAD/ CHF guideline recommendations
and performance measures
– Coordinate care
• Create a visit summary to communicate with
patients and other providers
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IC3 Program: Incentives for
Practices
• Develop tools to improve care
– Provide real-time reporting of office-based
quality indicators for CAD and CHF derived from
clinical practice guidelines
• Create a trusted mechanism for measuring
performance
– Support evolving CMS outpatient quality
measures and regulatory reporting initiatives
– Support Pay-for-Performance programs with
payers
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Physician X’s Practice
Payer
Perspective of
my Performance
United (5)
40%
BCBS (9)
76%
Medicare (26) 100%
Medicaid (10) 100%
Physician X’s Overall Performance = 90%
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Partnering with Health Plans –
Benefits to Plans…
• Health Plans get Better Picture of Practice
Performance
– Clinical data prospectively measured
– More accurate assessment of practice
performance from larger sample sizes than
individual plans
– Capture of complete ACC/AHA performance
measures
• Plans need not develop their own
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Other IC3 Program Goals
• Position the profession (ACC) to take a leadership
role in quality assessment and improvement
• Support the evolution of quality assessment and
improvement
– Identify new opportunities to improve and coordinate CAD
and CHF care
• Create a research agenda to improve care
– Document the distribution of cardiac patients’ health status
– Identify new performance measures
– Support research of appropriateness
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Data Entered
through3 NCDR
IC3
Office Flow in IC
Pt presents
for visit,
reports med
changes
Vitals,
health
status
assessed
Data
entered
and Clinic
Visit Form
Generated
Physicia
n Visit &
Rx
Patient
Letter &
Visit
Summary
dispensed
Treatment
plan Data
entered
Visit
Summary
sent to
other care
providers
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Data Collection
• Types of data
– Site Profile captured once
– Patient History captured on entry
– Treatment monitored longitudinally
– Clinical event data captured
longitudinally
– Patient health status for CAD and CHF
(optional)
• Data collection tools
– Web-based data collection tool
– Paper forms
– Working on EMR integration for Decision
Support
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Data Submission and Reporting
• Data will be subjected to
completeness and consistency reviews
– On-site audit to ensure accuracy (2009)
• Quarterly aggregate practice-level
data reports and benchmark reports
• National benchmark performance
• Peer group benchmark performance
• Individual hospital performance
• Real-time QI reports generated for
individual and practice-level data
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Release
• Enrollment begins October 1, 2007
• Web-based data collection begins
Jan 1, 2008
• Training and roll-out for participants
• Client and contract support for
participants
• Marketing and communications to
broader physician community
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Participant Training and
Education
• NCDR Online website
• Information packet/Welcome Kit
• Online training manual
• Annual User Group Meeting
• Workshops
• Special web casts
• On-line community development for
collaborative learning and sharing
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For More Information…
Visit: www.ncdr.com/ic3
Email: [email protected]
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