Welcome to the STS-ACC TVT Registry Case Scenario, which will focus on utilizing a patient-level drilldown for metric 307, patients with acceptable quality-of-life outcome at 30 days based on KCCQ summary score, to determine why certain patients do not meet the numerator. This is an example of a frequent question we receive to the registry. I just looked at my drilldown for metric 307, and there are several patients who are not included in the numerator, and I cannot figure out why. Can you help? To begin looking at reasons for a patient not being included in the numerator for metric 307, we first need to review its metric criteria located in the 30-Day Follow-Up Executive Summary Measures and Metrics Companion Guide. First, we will review denominator exclusions. This metric will exclude any patient who had an aborted procedure or a procedure that was not the first TAVR in the episode of care or enrollment into a research study that is partnered with the registry, enabling sequence number 3020 to be coded as Yes. To meet the numerator, the patient record must meet all four parameters. The 30-day follow-up must be performed in the 23- to 75-day follow-up timeframe, and the follow-up status must be coded in sequence 11004 as Alive, and the lowest follow-up KCCQ score must be at least 45 and completed in the 23- to 75-day follow-up timeframe, and the follow-up KCCQ score must not decrease more than 10 points when compared to the base procedure KCCQ. Next, we will use fictitious data from patients who were not included in the numerator for metric 307. For ease of demonstrating this scenario, we have removed some of the columns that would normally be seen in the drill-down, and we will go through each patient and detail the reason the patient did not meet the numerator. For this patient, the 30-day follow-up was performed within the 23- to 75-day timeframe. The follow-up status was Alive, the follow-up overall KCCQ summary score was greater than or equal to 45, and the KCCQ was completed within the 23- to 75-day timeframe. However, the overall KCCQ decreased more than 10 points. Since not all four parameters were met, they would not be included in the numerator. In this scenario, the patient had a 30-day follow-up performed within the 23- to 75-day timeframe, and the follow-up status is Alive. While the patient does have an overall KCCQ summary score of greater than 45, it was not completed within 23- to 75-days post-procedure, and the overall KCCQ summary score decreased by more than 10 points. Since not all four parameters were met, they would not be included in the numerator. In this scenario, the patient had a 30-day follow-up performed within the 23- to 75-day timeframe. However, follow-up status is Deceased, and no KCCQ had the opportunity to be performed. Since not all four parameters were met, they would not be included in the numerator. The patient in this scenario did have a 30-day follow-up performed within the 23- to 75-day timeframe and was coded as Alive in the follow-up status. However, the overall follow-up KCCQ summary score was not more than 45, and it was completed on day 78 post-procedure, which is outside of the timeframe. Since not all four parameters were met, they would not be included in the numerator. The last patient in this scenario did have a 30-day follow-up performed within the 23- to 75-day timeframe and was coded as Alive in the follow-up status. And while the follow-up KCCQ was performed within the timeframe, the overall score was not more than 45, and it decreased more than 10 points. Since not all four parameters were met, they would not be included in the numerator. Tips for reviewing the patient-level drill-down include download the drill-down in an Excel format. This will allow for editing of columns and rows that may not be helpful in determining why a record did or did not meet the numerator. Review the drill-down using the 30-day follow-up executive summary measures and metrics companion guide that outlines metric criteria. This guide can be found by going to the Resources tab on the left navigation bar and selecting Resources, Documents, Executive Summary Measures and Metrics Companion Guide Documents, and 30-Day Follow-up Executive Summary Measures and Metrics Companion Guide. And lastly, understand the denominator exclusions. Thank you for viewing the TVT Registry Case Scenario.

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