Washington State Emergency Cardiac & Stroke System of Care. Sample proof of concept Report Cardiac Measures

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1 Washington State Emergency Cardiac & Stroke System of Care Sample proof of concept Report Cardiac Measures COAP IN 2011

2 COAP IN 2011

3 Washington State Emergency Cardiac & Stroke CLICK TO EDIT MASTER TITLE STYLE System of Care Sample proof of concept Report Cardiac Measures Click to edit Master title style Julie McDonald, RN, BSN, CPHQ Chair, ECS Data Committee Chair, COAP Management Committee Director Clinical Analytics, Providence Regional Medical Center, Everett

4 Quality Improvement Protection The programs of the Foundation for Health Care Quality have been approved by the WA State Department of Health as Coordinated Quality Improvement Programs (CQIP) under: RCW A CQIP may share information and documents with one or more other CQIPs or committees or boards and shall not be subject to the discovery process

5 Emergency Cardiac & Stroke (ECS) System of Care COAP was asked to assist with helping to create a system of measurement using available data sets, which would meet the requirements for participation NCDR CathPCI data base + NCDR Action (ARG) data base together provide the essential data elements needed for this system of measurement COAP & Armus created a special report from these combined data sets which measures the outcomes specified by the ECS Technical Advisory Committee and which will meet the requirements for participation In order to provide this service to its members and to the state, all hospitals not currently participating in CathPCI will need to join. Data collection will not change, and will continue to be provided through COAP. All hospitals wishing to take advantage of this special reporting option as a way to meet the requirements for their cardiac level I or II status will also need to join Action/ARG..

6 Emergency Cardiac & Stroke (ECS) System of Care Grant funding from the Department of Health has been provided to COAP to assist with the ECS data project COAP will use that grant funding to pay for 2012 membership in CathPCI and Action/ARG for all hospitals not currently enrolled. Enrollment must occur before September in order to take advantage of this Please pick up your hospital specific enrollment packet at the back of this room before you leave the conference today. Further information will be sent following the conference. Contact Kristin Sitcov with questions.

7 Recommended Measures for Cardiac* Hospital/EMS Measures Time on scene Percent of AMI patients who arrived by EMS Percent of AMI patients for which pre arrival notification from EMS was received Percent of AMI patients who get any reperfusion (PCI or lytics) Percent door to balloon in 90 minutes Percent door to needle in 30 minutes Time from onset to 911 call (activation) Time from first medical contact to treatment (EMS or first hospital if transferred in; arrival at first hospital if self transport) Time from onset to treatment Outcomes (died in hospital, discharged alive, discharge location) CMS AMI Core Measures Function at 3 months (wish list or study) Cardiac arrest measures to be determined * Source: Emergency Cardiac & Stroke Technical Advisory Committee State Level Measure (Collected by DOH from CHARS and Vital Statistics) Hospitalizations (AMI, out of hospital cardiac arrest) Length of stay Discharge status Mortality 30 day readmission (future) 30 day mortality (future) One year mortality (future) Suggested Local/Regional Level Measures/Data Points Call receipt at first PSAP to actual dispatch Time in transfer hospital Percent of AMI for which ECG performed prehospital Accuracy of pre hospital ECG

8 Proof of Concept Report Data Sources: COAP/CathPCI data AR G (ACTION) data Draft ECS System of Care Report

9 Hospital A Hospital B Hospital C Hospital D

10 Hospital A Hospital B Hospital C Hospital D

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15 Data Tables

16 Process Timelines (will be reported by site as well) Critical Process Timelines: Non-Transfer In Patients Receiving Hospital Report, Q1-Q Aggregate National Number of Records 420 Q Eligible Cases Rate (Minutes) 4407 Pre-Hospital ECG (Arrival by EMS) Symptom Onset to Device Activation Symptom Onset to FMC FMC to ECG ECG to ED Arrival ED Arrival to ED Out ED Out to Cath Lab Arr Cath lab Arr. To Dev Activation ECG after Arrival (Arrival by EMS) Symptom Onset to Device Activation Symptom Onset to FMC FMC to Arrival Arrival in ED to ECG ECG to ED Out ED Out to Cath Lab Arr Cath lab Arr. To Dev Activation ECG after Arrival (Arrival by POV) Symptom Onset to Device Activation Symptom Onset to ED Arrival ED Arrival to ECG ECG to ED Out ED Out to Cath Lab Arrival Cath lab Arrival to Dev Activation Bars are not displayed when there are no eligible patients in the time frame. Additionally, specific time intervals with median of 0 are not plotted. EMS = Emergency Management System POV = Personal Occupancy Vehicle FMC = First Medical Contact ED = Emergency Department Aggregate Average Times Symptom Onset to FMC FMC to ECG ECG to ED Arrival ED Arrival to ED Out ED Out to Cath Lab Arr. Cath lab Arr. To Dev Activation Symptom Onset to FMC FMC to Arrival Arrival in ED to ECG ECG to ED Out ED Out to Cath Lab Arr. Cath lab Arr. To Dev Activation Symptom Onset to ED Arrival ED Arrival to ECG ECG to ED Out ED Out to Cath Lab Arrival Cath lab Arrival to Dev Activation Reference: American Heart Association - Mission Lifeline; Duke Clinical Research Institute - Duke University Medical Center

17 Composite Adherence (will be reported by site as well) Overall Composite Adherence Receiving Hospital Report, Q1 Q Achievement Measures 1 Aggregate Adherence Score (Correct Care) 3 National Q Adherence Score (Correct Care) 4 Overall Mission Lifeline Composite Score 93.9% 94.7% Acute Therapies: 1 Arrival to Primary PCI <= 90 min 94.4% 91.2% 2 FMC to Primary PCI <= 90 min 61.2% 56.5% 3 Reperfusion Therapy 83.8% 93.9% 4 Aspirin at Arrival 97.5% 98.9% Discharge Therapies: 5 Aspirin at Discharge 97.9% 98.6% 6 Beta Blocker at Discharge 95.7% 97.4% 7 Statin at Discharge 94.5% 98.5% 8 ACE inhibitor/arb at Discharge in LVSD 78.9% 89.4% 9 Adult Smoking Cessation Counseling 98.4% 98.3% 1 AR G Mission Lifeline receiving center patients have nine Achievement measures for which they may be eligible 2 Total number of treatment opportunities among eligible patients within the reporting timeframe 3 The ratio of total received therapies for all patients at a single site or aggregate of sites out of the total number of opportunities for all patients at that site or aggregate of sites. (Number of times care matches guideline recommendations / Number of guideline opportunities ) 4 The ratio of total received therapies in the previous quarter for all patients in receiving centers in the nation, out of the total number of opportunities for all patients in the nation. (Nation Among all admissions from receiving hospitals in ACTION Registry GWTG) Reference: American Heart Association Mission Lifeline; Duke Clinical Research Institute Duke University Medical Center

18 Aggregate Denominator # Missing Means of Transport to First Facility Pre arrival First Medical Contact Date and Time, IF Means of Transport to First Facility = 2 (Ambulance),3 (Mobile ICU) or 4 (Air) Transferred From Outside Facility Arrival at Outside Facility Date and Time, IF Transferred From Outside Facility = 1 (Yes) Transfer From Outside Facility Date and Time, IF Transferred From Outside Facility = 1 (Yes) Arrival Date and Time Onset Date and Time First ECG Obtained (Pre Hosptial or After First Hosptial Arrival) First ECG Date Time Location of First Evaluation Transferred out of Emergency Department Date and Time, IF Location of First Evaluation = 1 (Yes) PCI Cath Lab Arrival Date and Time, IF PCI = 1 (Yes) First Device Activation Date and Time, IF PCI = 1 (Yes) PCI Indication, IF PCI = 1 (Yes) Non system Reason for Delay in PCI, IF PCI_Indication = 1 (Immediate primary PCI for STEMI) Reperfusion Candidate, IF Discharge Date < 04/01/11 (there is no parent and data should not be missing); IF Discharge Date 04/01/11 and STEMI/STEMI Equivalent = 1 (Yes); (data should not be missing if new Parent STEMI/STEMI Equivalent = 1 (Yes)) Primary PCI, IF Discharge Date < 04/01/11 then Primary PCI will not be in the Denominator or # Missing as field did not exist; IF Discharge Date >= 04/01/11 and Reperfusion Candidate = 1 (Yes) 99 0 Thrombolytics, IF Reperfusion Candidate = 1 (Yes) Thromboytic Therapy Date and Time, IF Thrombolytics = 1 (Yes) 8 0 Non System Reason for Delay (Thrombolytic Therapy), IF Thrombolytics = 1 (Yes) 8 0 Sample Missing Data Report (will be reported by site as well) Missing Data Report for Action Composite and Timeline Metrics, Q1 Q2 2011