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Figure 1: The Central Role of Data and Benchmarking in
professional organizations in specific areas where appropriate. For
Quality Improvement
example, the ACC and AHA partner in the ACTION Registry
®
—Get With
The Guidelines (GWTG™), just as they partner in the development of
Quality improvement
data standards, guidelines, and quality measures for acute myocardial
infarction (MI). The CathPCI registry naturally links the ACC with the
Society for Cardiovascular Angiography and Intervention (SCAI) and,
similarly, the Implantable Cardioverter Defibrillator (ICD) Registry
naturally links the ACC and the Heart Rhythm Society (HRS). The CARE
Iterative evaluation
Registry reflects the multistakeholder nature of carotid revascularization
System changes:
through its seven partnering organizations. Data Benchmarking
information technology
protocols
Data Collection
collaborative care
The data collection goal for each NCDR program is to assemble a
parsimonious data set based on existing data standards that will enable
Clinician leaders
assessment and feedback of guideline concordance of care and quality
metrics, including both process of care and outcome measures. Examples
Administrative support
of quality metrics for the CathPCI Registry include door to balloon time for
patients with ST-segment elevation MI, vascular complications, need
Table 1: The National Cardiovascular Data
for urgent coronary artery bypass graft surgery, and risk-adjusted
Registry Programs
in-hospital mortality based on the validated, National Quality Forum-
endorsed NCDR risk model. Examples of ICD Registry metrics include
Registry Clinical Area Partnering Participants/
peri-procedural complications, guideline-indicated medication use rates,
Program Organizations Records and utilization measures such as type of ICD used. The ACTION Registry—
CathPCI Diagnostic cardiac ACC, SCAI 1,144 hospitals,
GWTG measures key processes of care for patients with MI ranging from
catheterization and >10,000,000
time to reperfusion therapy (for both direct arrival and transfer patients)
percutaneous coronary patient records
and delivery of evidence-based medications throughout hospitalization to
intervention
risk-adjusted in-hospital mortality.
ACTION Acute myocardial ACC, AHA, 456 hospitals,
Registry
®
— infarction SCPC >125,000
GWTG™ patient records
The CARE Registry, which includes assessment of both carotid stenting and
ICD Implantable ACC, HRS 1,482 hospitals,
carotid endarterectomy, collects data necessary to evaluate procedural
cardioverter– >400,000
indications, peri-procedural complications, and patient outcomes,
defibrillator patient records
including 30-day outcomes. Of note, the neurological outcomes captured
CARE Carotid ACC, SCAI, SCVIR, 185 hospitals, in CARE include an independent neurological examination using the
revascularization AAN, AANS/CNS, >10,000
National Institutes of Health (NIH) stroke assessment tool, a key feature
(carotidy artery SVM patient records
for accurate assessment of patient outcomes following carotid
stenting and carotid
revascularization. Finally, the new office-based IC3 program collects the
endarterectomy)
data necessary to evaluate the ambulatory care performance measures
IC3 Coronary artery ACC, MedAxiom, 175 practices
for patients with coronary artery disease, heart failure, hypertension,
(Improving disease, heart failure, and Spirit of Women (>600 offices),
diabetes, and/or atrial fibrillation.
5
Continuous cardiac rehabilitation, >150,000
Cardiovascular hypertension, diabetes, patient records
Care) and atrial fibrillation
For all NCDR programs, the goal is to have data collection as embedded
IMPACT Pediatric and adult ACC, SCAI, AAP 11 pilot
as possible into the routine clinical workflow. For example, vendors of the
congenital cardiac hospitals
hemodynamic recording systems used in many cardiac catheterization
catheterization laboratories are certified by NCDR, such that data entered at the point of
care are automatically captured for subsequent transmission to the
AANS/CNS = American Association of Neurological Surgeons/Congress of Neurological
Surgeons; AAP = American Academy of Pediatrics; ACC = American College of Cardiology;
CathPCI registry. With the IC3 program, the NCDR works with individual
AHA = American Heart Association; HRS = Heart Rhythm Society; SCAI = Society for
practices regarding their preferred method of data collection and
Cardiovascular Angiography and Interventions; SCVIR = Society of Interventional Radiology;
SVM = Society for Vascular Medicine; GWTG = Get With The Guidelines™.
transmission. Increasingly, data can be extracted from electronic medical
records so data are truly collected as part of routine care documentation.
The CathPCI registry alone includes more than 10 million patient
records. The IC3 program, even in its pilot phase, includes over 175 Benchmarking
practices, representing 623 office locations in 48 US states and two US A core quality of care function of the NCDR programs is to provide
territories, and has over 150,000 patient records. reports back to participating hospitals and practices regarding their
care. These reports include both regional benchmarking (to ‘like’
It is important to emphasize that the NCDR registry programs are hospitals/practices) and national benchmarking. A sample section of
‘multi-organizational,’ whereby the ACC partners with other such a benchmark report is contained in Figure 2. It is intended that this
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