Hello, I'm David Bonner, the team leader of clinical operations at NCDR. I'd like to thank you for joining us today and welcome you to our pre-conference for the ACC's 2021 Virtual Quality Summit. This year, we're pleased to offer a four-part series of conversations with our Clinical Quality Advisor team. Today we'll be highlighting important information aimed to help lead you to a successful journey in transforming cardiovascular care and improving heart health. This first session is focused on NCDR fundamentals, where we'll discuss the why, why it's important for you to participate, why it's important for you to be fully engaged, and why it's essential for you to utilize the products and materials available to each of you. Before we get started, let's begin our conversation with a quick introduction of our expert panel of Clinical Quality Advisors. I'd like to introduce John Durroute. Hello everyone, welcome. Miss Denise Pond. Hi everyone, I really miss seeing you all. Melissa Nita. Aloha everyone. Karen Colbert. Hi everybody, welcome to the Quality Summit. Shelly Conine. Hi, I wish we were in Dallas together. Fernando Garcia Barbone. Hi everyone. Kristen Young. Hi all. Beatrice Patipudi. Hi everybody. And Yan Huan. Hi everyone. From all of us at NCDR, we'd like to extend a warm welcome to each of you, and especially thank you for your hard work and dedication to always strive for excellence in your quality efforts with ACC. Now to start our conversation about NCDR fundamentals, we first need to make sure we all know why we're here. So let's start with you, Kristen. Can you start off by sharing why NCDR participation is fundamental and how participation can be beneficial? Oh sure, and that's a great question. I think it really kicks off this session pretty well because I'm pretty sure that if you're sitting here and engaged in this conversation right now, you probably share the same mission as the NCDR, which is to transform cardiovascular care and improve heart health. But while we are interested in doing it at a global level, you get the really cool opportunity to do it in the communities where you live, work, and play. So the registry that you actually participate in, you have stakeholders at your organization who find value because it really is no secret that registry data enables not only clinical measurements but in regards to process improvement to ensure that you're doing best practice and to ensure quality outcomes. And it's available to not only your clinicians, but it's available at the hospital level and even at a hospital systems level. Now is there value in benchmark reporting? Yeah, so you probably know this, but you're doing all of this data abstraction internally and then by abstracting that data, you get to interpret it by looking at the dashboard and using metric results to drive quality improvement. And on the dashboard, you get to compare results to a benchmark or even like hospitals. Thank you. One of the things that we always say here is that it enables measurement by clinicians, for clinicians, and hospitals and hospital systems. So it's an important venue to be a part of. Thank you for that. Now registry participation requires a lot of dedication and diligence from each one of our participants, regardless of what role they're playing. Shelley, can you explain why it's fundamental for a participant to engage in all the resources NCDR provides? Oh, sure. It is important for participants to engage in all NCDR resources for several reasons. This is to ensure standardized training and orientation, providing the same consistent message to all, to ensure each user of the registry is following the same structure for data abstraction, using our data dictionaries, and to ensure each facility is equipped to interpret and make use of the aggregated data that is provided on the executive summary benchmark and metric results displayed on the NCDR eReports dashboard. Very good. So when Shelley is talking about resources, John, could you expand a little bit and highlight some of the valuable resources that NCDR provides? Yeah, sure. I'd be happy to. So it really begins for new users with our Start Here link, and that really takes you to the NCDR orientation, where we have videos and links, documents, and other detailed instruction, and that reaches both our domestic audience and our global audience. From there, we have the NCDR QII Learning Center. There is over 80 lessons there right now, and it's growing continually. There are lessons that are available for continuing education credit, but there's also a non-continuing education pathway for those that are interested in that. We have at the QII Learning Center, it is a home for over 130 case scenarios. It will be the future home for ACC accreditation education and a place to review some of this quality summit information that you're watching right now all year long. We have bi-monthly registry calls or quarterly calls, depending on the registry. There are resources, documents, FAQ databases for every registry, participant resource sharing, so you can actually network with other participants and learn about their best practices. And ultimately, we have this skilled team of experts who are always here to assist you to the very best of our abilities. That's awesome. Thank you, John. Fantastic resources for our participant community. I hope everyone has had an opportunity to visit our QII Learning Center, because as John mentioned, with all the different educational materials we're putting there and our plan to add more over time, it's really a go-to place for you to educate your new staff and just learn more about NCDR registries and the quality that we're trying to help with. So most participants have an option to declare when they join ACC any particular registry. For the most part, they have an option to use the ACC online data collection tool or use a third-party vendor tool for data entry and submission. Now this isn't true in every situation, but for the majority of people in the registries, this is the case. So understanding data collection, data entry, data submission, working within the data collection tool, that's all fundamental. So Denise, can you take a moment and explain in more detail the difference in these tools and why participants might choose one over the other? Yes. As David has already said, there's two options in data collection tools. The first one would be your ACC online tool, which is available to all of you upon enrolling into the registry. Based on your facility's needs and desires, you do have the option to use a third-party vendor. A third-party vendor would have to be someone certified by our NCDR IT team, and the vendors used are different based on the registries that you participate in, and they can be found on your administration page. They can provide customized reports for your facilities, and they have the ability to interface with your facility's EHR and your cath lab equipment. But no matter which data collection tool you use, please remember that your go-to is your ACC online tool, because that is where you'll find announcements on the homepage of each registry, which keeps you informed regarding any changes, any updates in the registry, your DQR reports, your dashboard results, resources such as FAQs, case scenarios, the learning center, and much, much more. So remember, if you use a third-party vendor, please do access ncdr.com at least on a weekly basis to check out the announcements and the resources available to you. And that's awesome. Thank you, Denise. I just want to make sure I clarify one point. You did mention that the go-to is the ACC online data collection tool. I think you meant to say the go-to is ncdr.com, so you can review the webpages. So there is an option of a third-party vendor or the ACC online data collection tool. Just want to make sure that's clarified. And just to clarify again, the decision to use a third-party vendor tool based on what your needs are in your facility is completely at the discretion of the hospital. Is that correct? Yes, it is. Absolutely. So there's no requirement for that. And let me see here, Kristen, with the STS-ACC-TVT registry, I don't think you have a third-party vendor option at this point. Is that correct? Not at this point, no, but it's in the works. Okay. All righty. Well, thank you. Thank you all very much for that. So working within the registries, the scope and complexity of the registry is a lot of information for people. It's a lot of hard work for people. One thing that we get from our participants is the question about the quality of our data. How can we make sure, because trust in the data is fundamental, how can we make sure that the data is good, clean, quality data and our participant community have trust in that data? Fernando, can you take that? Yeah, of course. So the NCDR has put several processes in place to make sure that the data that we use to aggregate our reports meet a high-quality standard that starts with the threshold that we assign for all the elements and it's followed by the quality check as well as the DQR process. Each of these processes makes sure that the data is checked for logic as well as for a completeness assessment that is performed. Not only do we make sure that the data that we receive is high-quality, but we also offer Some of our registries have a self-audit tool that facilities can use to audit themselves and make sure that the data is consistent, that it's entered. We also perform an official randomized audit on a yearly basis for every registry. And not only do we make sure that the data we receive is high-quality, but we also audit ourselves in this team to make sure that the data or the answers that we sent out are always correct and are consistent. So you can make sure that your data is going to be checked as well as the responses that you receive from us are also checked with the same lens. And that's a really important point, Fernando. Thanks for bringing that up. You know, with several people answering questions in the data registries, we have sorted out where we have specific expert resources assigned to certain registries, but we definitely have to make sure all the answers we send out and all the communication that's provided matches. And we all stay on the same page and there's no discrepancy in the data. Now, even as much as we do, sometimes there can be something that's questionable, gray areas, but we do, this team, and I will attest to that, does an exceptional job at trying to minimize any area of confusion and trying their very best to make sure that they stay in line with our high-quality standards. So thank you for that. So elements set into thresholds, every element has its own threshold. Our quality check process, our DQR process, self-audit tools for participants, I think we have that in four registries, if I'm correct with that, and our randomized audit process that's done on an annual basis. Anyone else have anything they'd like to say about that? Yeah, one comment I would like to make, which I think is probably of interest to the participants, is that with the external audit, we audit about 10% of our sites, and the agreement rate is over 90%, and that's across all registries. So I think that just paints a picture that you all are doing an awesome job. You're following the data dictionary. You are following the guidance that you receive from the registry. So congratulations to you. Yeah, that's awesome. Thanks for bringing that up, Denise. And that's a very great point. The participant community is definitely invested in providing and doing the very best that they can to make sure that the data they're entering, the results they're getting, regardless of what those results are, are real, true results so they can improve quality. So thank you all for bringing up those points. Now switching gears just a tiny bit, NCDR aggregates and publishes the National Registry Benchmark four times a year. These benchmarks are based upon our Call for Data Schedule, which is available on every registry website. So let's discuss some details about the Call for Data Schedule and explain to our participants why this schedule is fundamental. Melissa, you mind talking about that? Yes, thank you, David. So every registry has a Call for Data deadline and you can find that on your website. It's important to adhere to the Call for Data Schedule because if you're not meeting the data deadline, and we also emphasize submit early, submit often to get a green, you're not going to have a complete picture of your rolling four quarters of how you're performing when you're looking at the dashboard. So we always want people to not wait to the last minute to follow the data deadline schedule. And it's posted and we also send out reminders two weeks before the data deadline that it's coming up. Now, does this schedule define the quarters for what's put into reporting? Yes, the quarters are defined by the patient's discharge date. So it's also important to adhere to watch what quarter is being reported. And you can find that on the website. Okay. John, what happens if a participant misses the data deadline? So it's, I mean, ideally you don't want to miss the data deadline because then your data that you're submitting won't be included in the published outcome that is for the next quarter. However, it's perfectly acceptable to submit your data after the data deadline because it will be included in the following published outcome for the next quarter. Right. Also, when you submit your data, it is going to be aggregated at a weekly basis. We do a weekend refresh of aggregated data, and you can appreciate your data in an unpublished timeframe. Yeah, very good. Does anyone want to talk about why we can't move data deadlines, except when it's something that NCDR has determined as an extreme case? Does anyone want to talk a little bit about our obligations to other stakeholders? Yeah, I can do that also. Sure, thanks. So every registry has a data deadline, but in the backside, what you don't, you may not know is that each registry also has obligations to other entities that look forward to seeing your data. And so if the data deadline is pushed back, then it starts affecting all of the registries because it's a logistical, statistical maneuver. If we change one data deadline, it'll affect another registry. And so the reports have to be published and submitted to the entities. We have a deadline also. So when we have a data deadline, it's not just for facilities, but it's also for NCDR. We have to meet deadlines to provide reports to other organizations. Thank you, Melissa. So that's a real good point. And I just want to make sure that the participant population understands it's not that we're not empathetic to the fact that maybe a deadline was missed, but there are just so many contractual obligations we have that it's an impossible task to shift deadlines to make sure everyone met it. So I just wanted to make sure we covered that just a tiny bit. So participation in NCDR brings value and excellence to hospitals throughout our country, as well as globally. Let's review 10-step processes which are fundamental to every NCDR user to ensure their hospital can maximize success in the registry. Beatrice, I wonder if you could start us off with step one. Okay. The first step to NCDR registry success is to use your NCDR educational resources. As a few of my colleagues already mentioned, the QII Learning Center is your go-to for specific courses and lessons that you need to reach your competencies and to be successful. And the second step is to remember to abstract accurate data always. And in order to do that, it's invaluable to involve all the staff, especially the cath lab, EP, the floor nurses, admitting everyone that's involved, not only to give them updates on how the registry is doing or how your facility is doing, but also emphasize the importance and the crucial part they play in capturing data. Thank you, Bea. Does anyone want to take a stab at step three? Sure. Next step, once the good care is provided, it is to abstract the data or the information according to the data registry and dictionary. There are targeted values for each element. And if you have any questions and need clarifications, you can use the resources, or you can email the CQA team and see if we can help you. And then the next step is, once the data is abstracted, then you need to use the dictionary tool online with the ACC NCDR or use the third-party vendor to getting all the data in the database. Absolutely. And then what happens? Well, after all the information has been entered into the database, each and every entry should have a quality check done. This is not just important for the initial entry. It is also very important to run that quality check each and every time you change data. And that would be true for the base procedure or if your registry has follow-up. Any changes in data, please run the quality check because then you're going to avoid something called a system alert, which will prevent you from entering your data. After that, please remember, submit your data to our online data quality review process because what you're looking for is evaluation of your data for both data assessment and completeness assessment. Thank you, Karen. Anyone want to take the next one? Sure, I will. So in addition to that, you want to review your DQR status and ensure that you've got green status when possible to ensure that your data is included. This means a common theme that we say is submit early and submit often. So that means adhering to those data deadlines, as I mentioned earlier. In order to have that data included in the quarter, you want to have a green submission before the end of the data deadline. And then lastly, once you've submitted all your data, you get the data back to you in the outcomes reports or executive summary measures and metrics on the eReports dashboard. So you want to review these executive summary benchmarks and metrics and identify opportunities to improve quality. So that's the first step. That's awesome. And then, you know, take all of that information and work in multidisciplinary teams to maximize the results of all the hard work you're all doing. Let me just summarize the the steps you said. So we're going to use our educational resources and the training and orientation that we have available. And then make sure that when you're using that, you're going to abstract accurate data all the time. Code using our target values and our data dictionaries. And all through the instructions. Call us if there's gray areas in those instructions or email us. But then enter your data that you've diligently abstracted into our online data collection tool or your third-party vendor. Run every patient through a quality check. Submit that patient or every patient to our data quality review. Review that status, the DQR status, to make sure that everything that was charted and entered for that patient is a green status and good quality data. Always make sure you're following the data deadline. Review the executive summary benchmark and metrics once we publish those results. And then work in your multidisciplinary teams to maximize all of your hard work. And ultimately, our goal is to transform cardiovascular care and improve heart health. So that's the first step. And then the second step is to improve heart health. So those steps are all very fundamental. Now, we're running quick on time. So I have a couple questions that were sent to me from the audience in the chat. So I'd like to ask the group a couple of questions here. The first one says, I'm always trying to stay on top of information coming out of NCDR. If you could list one main way for me to get information, what would that be? I can take that one, David. Sure. The main source of information for every registry is always going to be your homepage announcements. That's going to keep you the most up to date with what's going on with your registry. And as I think somebody alluded to earlier in this talk, please, this is something to look at every week, at least. I agree with that. And, you know, we do the very best we can to get information and announcements up in a timely manner. Sometimes it just depends on what's going on and how soon we find out about things. But we really do try to keep real-time communication going with you guys. Another question is, I'm loving the QII Learning Center and find it very helpful in my training and orientation for new staff. Will you continue to grow the Learning Center? And as always, we love our case scenarios. Will you continue to add more case scenarios? And, you know, I think I could take that one. The Learning Center will continue to be populated with new information. We have a track now for the Quality Summit. So I think we're hopeful that information will be populated there. We also have an accreditation track for those people who can be learning things and taking mandatory video and assessments in that particular vein of the Learning Center. And then, of course, to answer the question about our case scenarios, yes, we create a new case scenario for every registry and we plan on continuing to do that on an ongoing basis. So those are always there at your fingertips. Does anyone have anything to add to that question? Since I took it, I didn't mean to take it. I just think that the participants who have not used the Learning Center need to know that you can get CME credits for some of the activities. So I know there are some states that mandate credits be achieved to renew your license. So this is all included in your registry fee. There's no additional charge. It's free. That's awesome. Thank you for bringing that up, Denise. Here's another question. We participate in registry calls and appreciate the questions from your peers format. Just wanted to thank the team for all the efforts to help us. I noticed a contact us link on the registry homepage. Should we be using this for questions? I can take that one, David. The participant is asking how they should reach out and contact us. Well, I can take the question. I didn't mean to overstep. Yeah. So the contact us tab is the newest way of contacting us. It's also the best way to contact us because you will have a confirmation email with your case number, I believe. So you can always reference back to that if you, for some reason, don't hear from us, which is not going to happen. You'll always hear from us. But in the case that something happens you haven't heard from us, you can always refer back to that case number. And it's the fastest way that we are going to get your question. Thank you so much, Fernando. And with that, what I would like to say is that we've kind of run out of time. We reached our allotted time for this session. We'd like to thank all of you for participating and attending this conversation with the experts called NCDR Fundamentals. There's a lot more fundamentals that we could discuss, but we do hope that you learned something useful today. I'd like to do a special thank you to the Clinical Quality Advisor team. They're very diligent and I can attest they work so hard to make your lives easier. So I'd like to thank you all for all the dedication and the fine work that you're doing. So please make sure to join us in our next session, which is occurring right away. The next session is focused on our e-reports dashboard, so plan to attend that one as well. We'll see you all soon in session two. See you guys. Bye. See you soon. Bye. Bye.

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