Welcome, and thank you for joining this session. My name is Connie, or as you see here, Cornelia, and as the product manager for both the chest pain in my registry and cath PCI registry, I'm going to review what participation looks like for each registry, as well as address some of the most frequent questions we receive on how these sister registries are similar and how they are different. Cornelia will also touch on how each registry supports patients, providers, and organizations. The objectives for this presentation are to explain the purpose and aim of each registry, review the ACC AHA clinical practice guidelines that are the basis for each registry design, examine registry inclusion criteria, and identify opportunities for maximizing quality improvement through participation in one or both registries. Before we dive into registry specifics, it's helpful to understand why the registries are here. The American College of Cardiology began the National Cardiovascular Data Registry, or NCDR, to help improve the quality of cardiovascular patient care by using information to drive knowledge growth and provide tools for implementing quality initiatives while supporting research. The cath PCI registry was launched in 1998, and in 2007, the chest pain in my registry, formerly called the Action Registry, debuted. Beginning with the cath PCI registry, let's review the registry purpose, scope, and participation requirements and submission options. The cath PCI registry is a quality improvement vehicle for tracking outcomes related to diagnostic coronary angiography procedures and percutaneous coronary interventions, or PCI. It is the largest national surveillance system that assesses the characteristics, treatments, and outcomes of patients in PCI procedures. The registry provides organizations the tools to optimize outcomes in the management of patients with coronary disease through the implementation of evidence-based guidelines, in this way helping them improve the quality and safety of coronary disease care and providing opportunities to investigate novel quality improvement methods. The registry provides national benchmarking on the appropriateness of PCI and risk-adjusted outcomes. The registry patient inclusion population encompasses all adult patients greater than or equal to 18 years of age who have a qualifying registry procedure. These include diagnostic coronary angiography and percutaneous coronary intervention, or PCI. As mentioned, the cath PCI registry is a procedure-oriented registry. This means that regardless of the patient condition or status, any patient having one of these procedures will be included in the registry. The version 5 data collection form is designed to capture the information needed to report care and outcomes for PCI and or diagnostic-only procedures. The full data set, which means all data elements on the form, are applicable whenever PCI was performed with or without a diagnostic coronary angiography during the cath lab visit. The diagnostic data set refers to the elements highlighted in yellow. These are completed whenever a diagnostic coronary angiography was the only registry procedure performed during the cath lab visit. Note that whether PCI with or without diagnostic angiography or a diagnostic-only procedure is performed, not all data elements will be applicable to every procedure scenario. Because the registry collects data around two different procedures, there are two options for submitting data to the registry, all procedures or exclude diagnostic-only procedures. All procedures means PCI procedures with or without diagnostic and all diagnostic-only procedures are submitted. Alternately, sites may opt to omit diagnostic procedures when they were the only registry procedure performed during the episode of care, thus excluding their diagnostic-only procedures. Note that both options specify all PCI procedures are submitted. For those sites who do not perform PCI, they will select all procedures and submit their diagnostic procedures. The submission option selected will impact the metric report received. Sites are encouraged to submit all procedures as this supports receiving the most robust report. At this time, 70% of sites submit all procedures. The cath PCI registry is designed to provide insight into all aspects of the diagnostic and or PCI procedure by capturing the clinical rationale for the procedure, the condition of the patient up to and during the procedure, intricate procedure happenings, and post-procedure and discharge care. In this way, the registry effectively conveys patient and procedure outcomes, thus supporting hospitals focused on ensuring their pre- and post-procedure care processes result in the best possible patient and procedure outcomes. Finally, the cath PCI registry reports give participants insight into the risk-to-benefit ratio of performing PCI through benchmarked appropriate use criteria metrics aligned with the 2016 and 2017 manuscripts. Risk-adjusted outcome feedback is provided on the occurrence of acute kidney injury, PCI-related bleeding, and mortality, while additional metrics inform on the adherence to guideline therapies, adverse outcomes, and give feedback on length of stay. Now let's turn our attention to the Chest Pain MI Registry, reviewing the purpose and scope as well as discussing its unique focus. We'll also touch on these participant requirements and the submission options. As mentioned earlier, the Chest Pain MI Registry, formerly Action Registry, was launched in 2007. While the cath PCI registry formed a firm foundation for assessing cath lab procedures, it was recognized a national surveillance system was needed for patients with acute coronary syndromes, and more recently includes patients with chest pain conditions, so the patient characteristics and treatment strategies for all of these patients could be thoroughly understood. The primary aim of the registry is to optimize the outcomes and management of chest pain patients through the implementation of evidence-based guideline recommendations in clinical practice, to facilitate local hospital efforts to improve the quality and safety of care, and investigate novel quality improvement methods while providing risk-adjusted assessment of patients for comparison with national data. The 2017 AHA-ACC Clinical Performance and Quality Measures for Adults with ST-elevation and non-ST-elevation myocardial infarction provide the foundation for measurement of hospital performance based on process and outcomes of care. The Chest Pain MI Registry, or CPMI, patient inclusion population encompasses all patients greater than or equal to 18 years of age who are diagnosed with low-risk chest pain syndromes, unstable angina, and STEMI or STEMI. The CPMI registry is a patient condition focused registry. This means the registry inclusion criteria carefully outlines what documentation and patient evaluation meets the definition for each of these patient types. The inclusion criteria is strictly applied to ensure the registry captures only patients who meet the chest pain condition definition. The version 3 data collection form supports two types of data collection. The full data set, which means all data elements on the form which are applicable to the patient scenario are completed, or the basic data set, which means all data elements highlighted in yellow, which are applicable to the patient scenario, are completed. Once the data set type is selected, the health care organization can further specify which patient types will be submitted to the registry. As mentioned earlier, the CPMI registry is patient focused, collecting data on patients with low-risk chest pain, unstable angina, and STEMI or STEMI. However, while the registry can accept all of these patients, it is acceptable to submit a subsection of them. Here you see five submission options. If the full data set is completed, participants may submit all four patient types or opt to submit only the acute MI patients, which are those NSTEMI and STEMI patients. If the basic data set is completed, participants may submit all four patient types, only the acute MI, or simply their STEMI population. As with the CATH PCI registry, the most robust reports are received when all patient types are submitted. For your knowledge, 60% of participants are submitting all patient types using either the full or basic data set. Whether all patient types are submitted or a subsection, the chest pain MI registry captures the patient presentation, the evaluation performed by first responders and or the emergency department, the patient-specific treatments delivered, and the patient's discharge status and care strategies. Participation in the chest pain MI registry assures participants they will receive feedback on the 2017 performance measures for patients with ST-elevation and non-ST-elevation MI, as well as feedback on many other guideline therapies. Risk-adjusted outcomes are provided for bleeding and mortality. And if submitting all patient types, specific measures will help hospitals understand each step of their care processes, thus supporting their quality improvement efforts. As mentioned earlier, this session was designed to address some of the most frequent questions we receive. Now that each registry purpose and scope is clear, let's discuss the ways in which these sister registries are similar and review how they are different and in what ways they can support patients, providers, and organizations. As these graphics clearly demonstrate, the registries are designed to give hospitals a focused perspective that will support them in delivering the very best care aligned with the guidelines. Both registries help hospitals prioritize what they need to do. Still, participants often wonder why these two registries aren't combined into one, especially when there are several similarities between the Version 3 CPMI and Version 5 CAF PCI datasets. Collecting patient demographic information, details about the hospitalization known in the registry as the episode of care, gathering patient-specific history and risk factors, and the patient's medications on arrival and discharge, and finally, categorizing the patient's discharge status all appear quite similar. However, all hospitals participating in NCDR registries will collect similar information. In this case, both CPMI and CAF PCI will utilize this information to inform guideline care from their unique perspective. Were the registries to try and combine their patient populations, each patient scenario would require completing many more data elements, making data collection prohibitive. Keeping these registries separate supports unique analysis without increasing data collection effort. For those hospitals engaged in both registries and using the same data collection tool, select data elements are interoperable, which helps to combat this issue. Now let's look at some of the very specific ways the registries are different and what this supports. The CPMI registry has several data elements that collect the care delivered by Emergency Medical Services, or EMS, and specific details about the transferring hospital, including the hospital's AHA number. As care is delivered, the registry captures the serial nature of specific tests, such as ECGs and cardiac biomarkers, and identifies the revascularization treatment strategy, thrombolytics, PCI, or CABG, provided to relevant patients. The reporting of these data support conversations between EMS providers and the receiving hospital that can drive efficiencies in the processes of care and encourage coordination of care strategies that ensure quality patient care is delivered. To assist this conversation further, the registry is developing a distinct version 3 dashboard view for EMS organizations and individual participants. Likewise, the information collected supports inter-facility collaborations by providing all the data to start the conversation. Here as well, the registry is developing a version 3 transfer facility dashboard, which can be used to help organizations evaluate whether they and their neighboring hospitals are delivering the right care at the right time. Alternately, the CAHPS PCI registry collects the many different reasons patients present to the CAHPS Lab. The patient condition, the support they needed, and their exposure to contrast and fluoro are just some of the many procedure details cataloged. As PCI is performed, the intricacies of the lesion and the techniques used for revascularization are collected. As well, during and after each procedure, data elements capture if and when the patient experienced an event. The detailed knowledge gained about the patient and the procedure can drive cross-team collaborations. Armed with data about the patient, their condition, and all the procedure details, the clinical team can strategize how to better manage patient care to improve outcomes, such as decreasing PCI-related bleeding or managing patients with kidney injury. A multidisciplinary team will promote patient care from their own perspective. In this way, ensuring the best patient care is delivered. As a multidisciplinary team analyzes the patient care delivered prior to the procedure, during the procedure, and after the procedure, they can promote interdepartmental coordination of processes and care. Coordination from each department helps ensure the policy and practice changes needed to support quality patient care can be successful. As mentioned, metric reporting for each registry is designed to provide feedback that will help participants understand their adherence to guideline care. Here are examples that demonstrate how. Metric one, overall acute MI performance, provides CPMI participants with an understanding of how many eligible care opportunities they successfully delivered to their pre-admit STEMI and end STEMI patients. In this case, 1,437 care opportunities were delivered of the 1,523 identified for this patient population. This site delivered acute MI care opportunities 94.4% of the time. Metric 31 lets participants in the cath PCI registry know how many of their ACS patients received PCI procedures that were viewed as having a greater benefit to the patient than exposing them to the risks of PCI. In this case, 72% of ACS patients, or 216 of 300, received PCI appropriately. In both registries, the metric patient drill down will support a detailed review of the care provided and can be analyzed for quality improvement opportunities. However, at times the registries tackle the same guideline and this can feel duplicative. Here you see the aspirin at discharge metric for both registries. But on closer inspection and in comparing these two metrics for a typical site involved in both registries, we'll see we have different quality improvement opportunities. The CPMI metric has 191 pre-admit STEMI and end STEMI patients in the denominator. This metric will help us assess if this high acuity at risk population is receiving guideline care. Alternately, the cath PCI metric demonstrates we performed 740 PCI procedures. This metric will help us understand if all of our patients with cardiovascular disease who received PCI are also receiving this class one recommendation. In summary, the Chest Pain MI Registry is patient focused, evaluating the process of care from first medical contact through to discharge and reporting compliance with the 2017 STEMI and end STEMI guidelines. Care delivered by first responders and transfer hospitals help demonstrate all forms of reperfusion therapy delivered and support collaborative efforts. The registry is a vehicle for chest pain center accreditation and can help hospitals receive credit through public reporting with US News and World Report. The cath PCI registry is procedure based and focused on the care and outcomes of patients having diagnostic coronary angiography and or percutaneous coronary interventions. All PCI procedures, both non-acute and acute, are submitted to the registry where they are evaluated by the 2016 and 2017 Appropriate Use Criteria Guidelines. Collecting the details of the patient condition and cath lab visit support cath lab accreditation and participants can engage with public reporting to earn credit with US News and World Report. Individually, each registry is a valuable quality improvement resource. Collectively, these sister registries help hospitals understand all aspects of the care delivered to their acute chest pain patients and their elective population without active ischemic symptoms and can support improving patient care and cath lab procedure outcomes. Thank you for your time and attention. If you have any questions, please email ncdr at acc.org. For more information, visit www.ncdr.gov. For more information, please visit www.ncdr.gov. For more information, please visit www.ncdr.gov.

National Cardiovascular Data Registry

Cath PCI Registry

Chest Pain MI Registry

cardiovascular patient care

quality initiatives

outcomes