NCDR Update

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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
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20 Years of Performance Measurement
1987
2007
1997
Hospitals Physicians
HCFA CCP Pilot
IOM Rpt
JCAHO ORYX
CED
IOM Rpt
HCFA hospital mortality reports
AQA
Healthgrades
Leapfrog
JCAHO Agenda for Change
QPM to CMS
HCFA National CCP
NQF
HCFA HCQII
IOM Rpt
QPM to JCAHO
JCAHO Core Pilot
PQRI
HCFA 6 Natl Conditions
NCQA HEDIS measures
NCQA website
JCAHO Core Measures
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QCAREACCs 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

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QCARE
Q
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Ped. Registry
Imaging
CHD
EP Registry
ICD Long
PracMgt Registry
IC3 CAD Office
ACTION Registry
PAD Registry
CARE Registry
ICD Registry
HF Registry
CathPCI Registry
1997.. 2004 2005 2006 2007 2008 beyond
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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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• Registry/QI
• gt950 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

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• 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

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• Registry
• 235 Participants
• Data entry tool
• 3195.00/year
• ARS
• CMS required
• Research
• Performing analysis for FDA
• Discussion with CAS makers re PMS

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• Registry
• 250 participants
• No charge
• Funding provided by
• Genentech
• Bristol-Myers Squibb/Sanofi Partnership
• Schering Plough Corporation
• ARS
• Early discussions with payers

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D2B
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ACTION Registry (Acute Coronary Treatment and
Intervention Outcomes Network)Initial
Report1st Quarter 2007 Results


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2006-07 Data Submission Summary

• Admission of
  of of
  
• Timeframe
  Sites NSTEMI Records STEMI Records
• ACTION Jan. 1, 2007 227
  6,917 4,259
  
• Mar. 31, 2007
• CRUSADE April 1, 2006 280
  20,084 4,391
• Dec. 31, 2006

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ACTION Registry 2007 Patient Enrollment
Number of Patients enrolled
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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
(n26,902)
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In-Hospital Outcomes

• Variable NSTEMI
• (n 26,902)
• Death 3.8
• Re-infarction
  1.5
• CHF 6.8
• Cardiogenic Shock
  2.4
• Stroke 0.7
• RBC Transfusion
  8.9

Excluding CABG patients ACTION/CRUSADE DATA
April 1, 2006 May 31, 2007 (n26,902)
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NSTEMI Acute Medications


ACTION/CRUSADE DATA April 1, 2006 May 31, 2007
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NSTEMI Discharge Medications
Use
LVEF lt 40, CHF, DM, HTN Known hyperlipidemia,
? TC, ? LDL ACTION/CRUSADE DATA April 1, 2006
May 31, 2007 (n 26,902)
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New Hospital-Based Registries
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CathLab Congenital Heart Disease Registry

• Transcatheter device occlusion of CV
  malformations
• Atrial Septal Defect
• Ventricular Septal Defect
• Patent Ductus Arteriosus
• Fistula/Collateral VesselsBlood Vessel
  Communication
• Closure of Fontan Fenestration
• Transcatheter Balloon Dilation
• Transcatheter Stent Placement

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Pilot StudyEvaluation of Appropriateness
ofSPECT MPI

• The American College of Cardiology
• The American Society of Nuclear Cardiology

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SPECT MPI Registry Objectives

• Evaluate appropriateness
• Promote awareness of appropriateness criteria in
  practice
• Provide feedback reports to improve both
  practice-level and individual physician-level
  adherence to the criteria
• Establish benchmarks to guide performance
  improvement

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NCDR QI
NCDR D2B Take ACTION Field Consultants

• National QI Programs
• 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 ACTION?
•  

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Improving Continuous Cardiac Care
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Measuring the Continuum of CAD Care
AMI Care
Post-Hospitalization Risk factor
modification Cardiac rehabilitation
Patient with stable angina
Onset of Acute Coronary Syndrome
D/C
PCI/CABG
Admit
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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 Xs Practice
Payer Perspective of my Performance
United (5)
40
BCBS (9)
76
Medicare (26)
100
Medicaid (10)
100
Physician Xs 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 through NCDR IC3
Office Flow in IC3
Data entered and Clinic Visit Form Generated
Treatment plan Data entered
Pt presents for visit, reports med changes
Vitals, health status assessed
Physician Visit Rx
Patient Letter Visit Summary dispensed
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 ncdr_at_acc.org