Welcome to Lesson 1 of this learning activity titled Metric 1 – PCI in Hospital Risk-Adjusted Mortality – All Patients. The content in this lesson was developed by myself, Kate Malish, and I will also be narrating this lesson. The objectives for the learning activity are to understand the parameters of Metric 1, discuss detail line labels and explanations, interpret facility data in your dashboard and outcomes report. Before delving into Metric 1, it is important to know what resources are available to you and where to find them. When you log in to ncdr.com and choose CATH PCI Registry, please navigate to the Resources link, then click Documents. The registry has a robust collection of resource documents to assist you in every step of the data abstraction and interpretation process. The first section you will see is the V5 Data Collection Documents section, which contains the Hard Copy Data Collection Form, the Data Dictionary, and the V5 Data Dictionary Supplement with Pending Data Element Updates. This document further expands on certain data elements which also include Data Element Updates which are used for coding and will be added to the Data Dictionary upon next version upgrade. The next section of resource documents is User Guide Documents. This section contains helpful companion guides so that participants become comfortable with the DQR, the Dashboard, and the AUC. The Executive Summary of Measures and Metrics Companion Guide will assist you in understanding the registry's metrics. It includes detailed information on each metric so that you may determine which patients will be included. It also explains important terminology used such as numerator, denominator, denominator exclusion, and denominator exception. We recommend referring to this document whenever you are reviewing your facility's metric performance. Finally, towards the bottom of the resource documents page is our NCDR Risk Model Documents. This section contains helpful information on what a risk model is, how models are reported to NCDR, and how to interpret these models. These documents will give you a better understanding of why metric 1 is a risk-adjusted model and what that means for your individual performance. The model specifications for metric 1 are as follows. The outcome is simple. The patient had a discharge status of deceased as coded in sequence 10105. The metric measures the mortality rate of your facility on a rolling four-quarters basis. All data submissions must pass NCDR data inclusion thresholds and you must achieve a green status on your data submission for each quarter. The metric includes patients with a PCI procedure performed during the episode of care. Specifically, only procedure variables coded for the index PCI procedure are utilized by the risk model. Finally, the metric excludes patients who are transferred to another acute care facility on discharge, which would be coded as such in sequence 10110 discharge location. When sequence 10105 in the CATH PCI data collection tool is coded deceased, this patient will be included in the observed mortalities for your facility, pending there are no exclusions. Your dashboard will display this image showing the most recent four quarters and the status achieved for your facility for each quarter. Note only data submitted to the registry that achieved a green benchmark status is included in the My Hospital and U.S. 50th percentile data calculation. While a discharge status of deceased must be coded, the patient must also have undergone a PCI procedure, which is shown here in sequence 7050. Pay close attention to the data definition of PCI, as it includes both attempted but unsuccessful and performed PCI procedures once a guidewire is introduced into the body. Again, only the index or first PCI procedure is eligible for risk determination. Finally, patients are not eligible for metric one if they are discharged to an other acute care facility coded in sequence 10110 discharge location. Now that we have discussed the model specifications for metric one, let's turn our focus to the detail line labels. Understanding these labels and explanation forms a solid foundation for interpreting results in metric one. We will start by defining each detail line label, then we will revisit these detail lines later in the presentation when we view the dashboard. A metric's eligible patients are all patients included in the model. For this specific metric, eligible patients are those who had PCI during their episode of care. A predicted probability value is calculated for all eligible patients in the model. Model developers determine which patients are eligible and ineligible. In NCDR outcome reports, remember that any patient in a yellow or red data submission is ineligible. The observed or actual outcome is the unadjusted count of the outcome in the risk model. For metric one, the observed outcome is simply the number of patients undergoing PCI who had a discharge status of deceased. Then we have the expected or predicted outcome. This is the average of each patient's predicted probability of death for your specific site. This calculation involves risk factors for the patient, which are captured in the data collection tool, along with events which occurred during and or after the cath lab visit, which affect a patient's probability of death. As you know, a ratio is simply a comparison of two numbers using division. The O to E ratio compares the observed or actual mortality for your facility to the expected mortality. A ratio greater than one implies worse than expected mortality, whereas a ratio less than one implies better than expected mortality. The risk-adjusted mortality rate is an estimate of the hospital's performance that has been adjusted up or down to account for the hospital's case mix. Registry aggregate observed mortality rate is dynamic and changes based on the data from each quarter and the rolling four quarters. This concludes Lesson 1 of Metric 1, PCI in Hospital Risk-Adjusted Mortality, All Patients. Thank you for your participation.

Metric 1

PCI in Hospital Risk-Adjusted Mortality

Kate Malish

learning activity objectives

facility data