Welcome to Part 2 of this Learning Activity Module, CAP PCI Registry, Metric 39, PCI in-hospital risk-adjusted acute kidney injury, all patients. My name is John Giroud, and I will be narrating this lesson. Acute kidney injury after PCI is a common and serious complication of the procedure and is associated with an increased risk of myocardial infarction, dialysis, and death. Even small increases in serum creatinine have been associated with increased hospital length of stay. Acute kidney injury prediction and prevention should be a priority for participants because therapeutic options are limited once AKI develops. Metric 39 is helpful in providing risk-adjusted feedback on AKI, informing clinical decision making, and directing the use of strategies to avoid AKI and improve the safety of PCI procedures. The objectives of this learning module are to discuss and define what is post-PCI acute kidney injury, analyze and apply a systematic approach in understanding Metric 39, and utilize the eReports dashboard metric feedback. In Lesson 2, we will apply a systematic approach in understanding Metric 39 performance by utilizing the eReports dashboard, Executive Summary view, My R4Q performance, and the Metric Detail Line view. This lesson will also include case scenarios. The eReports dashboard provides a streamlined, centralized location to assess the facility's metric performance. It provides the user the ability to see metric details and the ability to drill down into the metric. The dashboard also provides patient detail information to evaluate individual patients and to evaluate the procedure details as well. The dashboard allows the user to filter data for a better understanding of the patient and procedure characteristics, as well as provider treatment patterns and facility processes. The ending time frame reflects data for a rolling four-quarter time period. The rolling four quarters is used to determine the metric value. My hospital R4Q performance is comprised of data included in the four quarters as specified by the ending time frame and is compared to the registry benchmark. U.S. hospital R4Q performance distribution is determined by the ending time frame. The 50th percentile is the registry benchmark. When reviewing Metric 39 PCI in-hospital risk-adjusted acute kidney injury for all patients, the facility metric performance is compared to the U.S. registry benchmark. The performance trend graph plots the facility's quarterly performance over a rolling eight quarters. The last four quarters are utilized to determine the rolling four-quarter metric value. Facility metric performance for the R4Q is plotted in a bullet graph. The dark blue line demonstrates facility performance and will end where the facility's R4Q metric value appears in relation to all U.S. registry hospitals. The bullet graph will provide the 10th, 25th, 50th, 75th, and 90th percentiles for Metric 39. The U.S. registry 50% metric benchmark value is derived from the performance of all CAF PCI registry facilities who achieved a green benchmark inclusion status for these quarters. The detail lines will display quarterly data for the rolling four quarters defined by the ending time frame. Detail line 4878, Eligible Patients, is comprised of all patients included in the model or all patients who had a PCI procedure attempted and or performed. A predicted probability of AKI is calculated for all eligible patients in the model. For detail line 4878, Eligible Patients, the risk model determines which patients are eligible and which patients are ineligible. When Metric 39 is reported, any submission receiving a yellow or red data benchmark status is not included. Detail line 4879, Observed AKI Among Eligible, is the count of occurrences of AKI or the number of patients who had AKI, the actual outcome. Those eligible patients who meet the definition of post-PCI acute kidney injury are reported in detail line 4879. Detail line 4880, Expected AKI, is the predicted rate of AKI for the eligible patients or the number of patients expected to have AKI based on the coding and capturing of the patient variables used by Metric 39 that we reviewed in Lesson 1. The model calculates the probability of AKI for each patient given the existence of risk factors for each patient. The Observed to Expected AKI Ratio or OERatio provides feedback on the comparison between the observed value to the expected value. When the OERatio is greater than 1, the facility experienced more AKI than expected. When the OERatio is less than 1, the facility experienced less AKI than expected. When the OERatio is equal to 1, the facility experienced the same AKI as the model expected. Detail line 4882 provides the facility's risk-adjusted acute kidney injury rate. The risk-adjusted rate for AKI is calculated by the hospital's OERatio and multiplied by the registry-aggregate observed AKI rate. Detail line 4883, the registry-aggregate observed AKI rate, is reflective of the patients included from all participating facilities during the reporting period. In order to be included in the registry aggregation, the submission to the DQR must receive a green benchmark inclusion status. The registry aggregation is dynamic and changes based on the data from each quarter and rolling four-quarter time period. Let's now apply what we've learned through a series of case scenarios. For the first case scenario, the registry site manager reviews the facility performance for metric 39. Based on the information being displayed on the executive summary page and the metric detail lines, the question we ask is, is the facility performing above or below the U.S. Registry benchmark? Is the answer to our first question, one, the facility is performing above the U.S. Registry benchmark, or two, the facility is performing below the U.S. Registry benchmark? And the answer is number one, the facility is performing above or better than the U.S. Registry benchmark. Continuing with our case scenario, the RSM reviews the facility performance for metric 39. Based on the information being displayed on the executive summary page and the metric detail lines, our question number two is, is the facility performing better, worse, or the same as expected? And the selections for question number two are, one, the facility is performing worse than expected, number two, the facility is performing better than expected, or number three, the facility is performing the same as expected? And the answer is number two, the facility is performing better than the metric expected it to perform. Their observed to expected ratio is less than one, meaning they had less observed AKI than the metric expected. An observed to expected ratio, or OE ratio, of greater than one implies the facility is performing worse than expected. An OE ratio less than one implies the facility is performing better than expected. And an OE ratio that is equal to one implies the facility is performing as expected. Continuing on with our case scenario, the RSM reviews the facility performance for metric 39. Based on the information being displayed on the executive summary page and the metric detail lines, our third question is, why is there no metric value displayed for the facility? And our available selections are as follows. Number one, there is no data submitted to the DQR. Number two, the ending time frame set on the dashboard is incorrect. Or number three, the rolling four-quarter submissions received a yellow inclusion status. And the answer is number three, the rolling four-quarter submissions received a yellow benchmark inclusion status. A yellow status indicates the submission is not included in the benchmark and comparison group statistics. The data has not passed the overall completeness assessment checks. The registry aggregate is benchmarking data that has passed the completeness assessment in the DQR and receives a green benchmark inclusion status, indicating the site has submitted complete data. This concludes lesson two of the CAHP PCI metric 39, PCI in-hospital risk-adjusted acute kidney injury, all patients. Now that you've completed this education, please click on the next lesson in the NEL series. Thank you for your participation. Thank you. Thank you.

John Giroud

CAP PCI Registry Metric 39

acute kidney injury

PCI procedures

eReports dashboard