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The National Cardiovascular Data Registry—Its Role in Benchmarking and Improving Quality
Figure 2: Sample Section of a Benchmark Report from the National Cardiovascular Data Registry CathPCI Registry
Percutaneous Coronary Intervention Quality Measures Worse Better
Proportion of STEMI Patients with DBT ≤90 Minutes
My hospital: 65% (rank: 87 of 389; rank percentile: 78)
Lagging Leading
The proportion of primary PCI patients with DBT ≤90 minutes. The goal is to have a DBT 23.9 36.4 50.0 63.0 76.9
of ≤90 minutes for all non-transferred patients having STEMI and having primary PCI
(detail line: 1,767)
Risk-adjusted Mortality
Lagging Leading
My hospital: 1.02% (rank: 118 of 366; rank percentile: 68)
2.44 1.71 1.25 0.94 0.73
Your hospital’s PCI mortality rate adjusted using the ACC-NCDR
®
risk
adjust model (detail line: 1,732)
Incidence of Vascular Complications
Lagging Leading
My hospital: 2.7% (rank: 286 of 401; rank percentile: 68)
4.3 3.0 1.9 1.1 0.5
Includes procedures with at least one vascular complication (detail line: 2,029)
®
ACC-NCDR = American College of Cardiology National Cardiovascular Data Registry; DBT = door to balloon time; PCI = percutaneous coronary intervention;
STEMI = ST-elevation myocardial infarction.
feedback with benchmarking will be used by hospitals and practices to data may be sufficient for some quality assessment purposes, claims data
target areas for improvement. For example, a hospital participating in generally do not include key variables such as disease severity (e.g.
the CathPCI Registry may find that they have a high vascular coronary anatomy) or comorbidities (e.g. degree of renal insufficiency)
complication rate compared with their region or the nation. This should that can directly affect clinical decisions and risk for adverse outcomes.
lead to an examination of cases with such complications—a root cause Moreover, claims data generally cannot differentiate comorbidities from
analysis—to determine whether process changes can be made to complications and usually lack indications for procedures, medications
reduce complications. Moreover, the NCDR and broader ACC and SCAI given, and exclusion criteria or intolerance of medications for a given
communities provide educational resources and sharing of best patient. Furthermore, data restricted to that available to single states or
practices to support quality improvement for participants. payers generally do not allow direct benchmarking to national data and/or
do not allow benchmarking of quality of care based on all of the patients
Recognition and Linked Incentives cared for by a given hospital or practice.
The NCDR now has a recognition program for participants achieving a
high quality of care. This program started in the ACTION Registry— For quality improvement to be effective, data must also be trusted as
GWTG, naturally building from the successful AHA Get With The being valid and accurate by clinicians. In contrast to claims data or other
Guidelines Recognition Program, and will be expanded throughout sources, NCDR participants submit their own clinical data, which are
the NCDR programs. The NCDR Rewards and Recognition program will then evaluated for internal consistency and completeness by the NCDR.
annually recognize hospitals and practices based on criteria linked to The NCDR maintains a robust data quality program, including use of data
established quality metrics, quality improvement, and leadership in the standards, training, and data checks for completeness and consistency,
field of quality of care. and an on-site auditing program to assess the accuracy of data entry by
facilities. Thus, the data in NCDR are clinical data reflective of the
In addition to local use of NCDR reports to support quality improvement, ‘denominator’ of care at a hospital or within a practice and are
data from the CathPCI registry and other NCDR programs are transparent to participants with regard to the validity of the data and use
increasingly used by hospitals and practices for external reporting to of the data to evaluate their quality of care. All of these factors are
states, health systems, and payers. For example, five states currently important to empower quality improvement.
require participation in the CathPCI registry, as do United Healthcare,
Blue Cross/Blue Shield, and Wellpoint for their cardiovascular quality Quality Initiatives and Tools
programs. The Centers for Medicare and Medicaid Services (CMS) In addition to benchmarking and feedback of clinical data and quality
mandate participation in the ICD Registry for data on primary prevention metrics, NCDR promotes quality improvement through allied
ICDs for Medicare patients, and the IC3 program is certified as a quality initiatives and tools. For example, NCDR actively promoted the
reporting solution for the CMS Physician Quality Reporting Initiative. Door-To-Balloon Alliance (www.d2balliance.org) among the NCDR
community of hospitals, and was a major source of measurement of the
There are several important reasons why data from NCDR programs are impact of the initiative. As another example, the ACTION Registry-GWTG
increasingly desired by states and payers for quality assessment. First, the will serve as the primary measurement source to evaluate the impact of
data are clinical rather than administrative, or claims, data. While claims Mission Lifeline (www.americanheart.org/missionlifeline).
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