Hello and welcome, everyone. Today we're here to talk about the quality of care metric for the EP device implant patient. My name is Carl Mingus, and I'm a research scientist at Yale School of Medicine. We are the data analytics center that was used to help to develop this composite metric for the ACC NCDR, and I'm excited to tell you more today about its development and how it can be utilized going forward in your institutions. So over the next 10 minutes or so, I'll be reviewing the quality of care metric measure, including which metrics were indicated, the process through which the metric was developed, and then where we stand within the current timeframe for implementation. From this presentation, you will also understand how to interpret your score, as well as how you could perhaps use it for meaningful quality improvement within your own sites. So composite measure development, and more broadly, public reporting, has dated back some time through the ACC's Board of Trustees Directive in 2009, when the motion was approved to begin these efforts. Feasibility phase was conducted for 1 year, and in 2011, there was an implementation plan for how to develop some of these measures, and then in 2012 to the present is really execution phase. So there's been quite a bit of time and consideration that have gone into development of quality composites, including the EPDI quality of care composite. So now onto the timeline for the development of the EPDI quality of care composite. So as you can see, this dated way back to 2016, when the work group was first formed to consider which metrics to include in the quality composite. Along the way, there were numerous steps, as indicated in this timeline here, of various levels of review from key committees within the ACC scientific team, comprised of physicians, statisticians, and leads from the registries. So this mainly included the MRM committee, as well as the CSQC committee that gave approval for the quality of care metric, in addition to the board, and a public comment phase for input from the public in relation to the quality of care composite and how it was developed, as well as the various weights that were utilized. We are now in the trial phase, and I will talk to you more about that later on in the presentation. So now that we talked about the sort of care that was taken to develop this quality of care composite for the EPDI registry, let's think about which metrics were included. So multiple, multiple metrics were considered for inclusion in this quality of care metric. They were all process metrics, but we arrived at the following two. Metric 14, which is a composite metric of discharge medications in eligible ICD or CRT implant patients. We also included metric 25, proportion of ICD or CRT patients that fulfill class 1, 2A, or 2B guideline indications. So these are the metrics that comprise the quality of care composite, and largely they were decided upon because it allowed for greater inclusion in terms of the number of sites they were able to report. So now that we know which metrics are included in the quality of care composite, let's talk about some assumptions that are important to note. First, this quality of care composite at this time only includes process measures. Those two measures that I mentioned before are simply process measures for discharge medications and guideline-indicated care. All metrics are derived from facility-level performance, not individual-level performance, so that's important to note. All values will be reported at a rolling four-quarter basis, so there's a full year's worth of data for consideration. No quarterly trend data are available. The EPDI quality of care registry was released as beta, which frankly means that it's a new measure that can be indicated to understand the uptake, the interest, and how sites can use it for quality improvement from a beta or testing standpoint before we go into further launch of the quality metric. And then finally, there was an equal weight applied for both of those metrics. As you see, they were both process measures. One is not perhaps considered to be more important than another, so they both contribute equally to the overall score of the quality of care metric, which we will go over momentarily. Before we get there, let's quickly discuss the eligibility criteria that a site must be able to adhere to in order to be included in the quality composite. So first, in order to report a composite, sites must be able to contribute both metrics, not just one. It must be both. If there are no eligible cases within the metric, a hospital is not eligible for a composite metric because they would not be able to contribute to the denominator. In an analysis of 2019 data, we found that about 6% of sites were excluded for one or both of these reasons. This was a total of 52 sites. So overall, the exclusion rates were quite small. So now for a look at the descriptive statistics of the overall quality of care composite. The overall number of hospitals that were included in this analysis was 819, just based on 2019 data. The mean score was 86.5%, with a standard deviation looking at sort of the spread of data around the mean of 13.3%. So that's a plus or minus value and indicates quite a bit of variability around the mean. The median value or the point of the 50th percentile score of all hospitals on the quality composite metric was 90.6%, with a 25th percentile being at 80.3%, and the 75th percentile being at 96.8%. So again, variability around the median value as well. So now on to your individual level data and what your site's data might look like. So in this example here, we're going to go through kind of how to interpret this score. So the overall score for this hospital was 87.2%, which meant that quality of care in terms of the process metrics that are included in the composite was achieved in 87.2% of cases. And this indicates a pretty high level of quality, but it still is at the 50th percentile. So measuring against that benchmark is important to understand how your hospital is performing and that for this hospital, there certainly is room for improvement in terms of improving the discharge medications and the guideline indicated therapies as well. So now that you know your score is, how can you utilize it? Well, first, the goal of NCDR, of course, is to think about it for promoting quality improvement within your own site and your own institution. So you might take that score, bring it back to senior leadership, and think about ways that you could utilize it to improve the own quality of care that's delivered at your institution. And it's perceived to be an overall view of quality of care provided from the standpoint of a process measure. So these are generally fairly easily adjustable and you can implement solutions to try to increase your score on that zero to 100 scale. The other value of a composite could, of course, be used for public reporting purposes. And this would be used if you're going to do a star rating nomenclature, such as one, two, three, or four stars, four stars being the best. The score would be applied against the pre-specified threshold. And this is important to note because it says sort of every site could get four stars. So as long as your site is putting in the work to achieve four stars and meet that threshold of whatever that score is going to be for four stars, then you're doing the work that you need to show that you can provide high quality of care. This will matter, of course, to your patients, your physicians, and other stakeholders as well. And of course, public reporting is nothing new to the ACC. This is a strategic effort that's been in place since 2008, as indicated in the JAC details below. And that paper really stated some of the key contributing factors for having a measure or quality composite, for example, be included in a public reporting initiative. And really, this would help to promote quality improvement, which we just talked about. Increasing the performance measures with scientific validity. This is necessary to get NQF approval, as an example. Increased in partnerships with physicians. All public reporting kind of measures do work with the scientific teams at the ACC NCDR to develop the various measures and metrics that are going to be utilized for public reporting efforts. Standardizing data elements and uniform submission processes are all important for public reporting programs to increase the efficiencies of the system. And that reporting should always occur at the appropriate level of accountability. So that way, it is modifiable. You also want to include a formal process for evaluating the impact of the program on the quality and cost of healthcare, including assessing the unintended consequences. So that's certainly why we are in this sort of beta phase, underwent public comment and other elements to try to roll out the most appropriate measure possible at this time. So as indicated in the overall timeline, we're going to dive sort of into the trial phase and where we've been with the quality composite over this past year. In January of 2022, we went live on hospital dashboards, as many of you are aware. Measures included the term test terminology in the nomenclature at this time, thinking that it was indeed a test measure. Between January and June, participants were able to review their data, talk to the key stakeholders, figure out if hospitals wanted to be included in the decision whether or not to opt in or not, as this is a voluntary measure. But monthly calls were conducted by the NCR with participants for training on how to understand the measure and utilize it within their own practices. And then questions were documented within ACC's CRM Salesforce for further reference. In July of 2022, all questions or comments were available for the CSQC to review, including those from public comment. And test terminology was reviewed from, was removed rather from the measure title for the quality composite. So in summary, now that you've spent some time learning more about our quality of care composite for the EPI registry, it's important to note first that it is strongly endorsed by ACC and the scientific team of lead investigators, world-renowned physicians, and others who have been instrumental in its development and getting across the finish line for sites to be able to be privy to the quality of care composite scores for their own institution. We see it as a reflection of overall quality of care in relation to the process metrics that were included. And this may be adapted in a later phase to include outcome metrics as well. We feel that that phase currently, it's a valuable metric for stakeholder engagement and improving overall quality in terms of the process measures, enhances our public reporting efforts as indicated in the previous slides, and has really been well-received by participants. Of course, we'll continue to monitor this and NCDR will use their platforms to continue to engage participants in the process. So thank you very much for your time and your commitment to quality improvement and to understanding more about the EPI quality composite. If you have any questions, feel free to reach out to ncdr at ncdr at acc.org, and they would happily get back to you with any questions or comments you might have about this measure or others. Thanks very much.

quality of care metric

EP device implant patients

development process

implementation timeline

quality of care composite