Welcome to Lesson 2 of this learning activity titled Understanding Metrics. The content in this lesson was developed by Denise Pond and Beth Denton. I'm Veronica Wilson and I will be narrating this lesson. The Chest Pain MI Registry Executive Summary Measures and Metrics Companion Guide is available by going to Resources and then selecting Documents. It can be used with the dashboard patient drill downs to provide detailed analysis of a hospital's individual performance in relation to the entire registry population. This gives insight into care variations and quality improvement opportunities, as well as the opportunity to compare hospital practice patterns to NCDR benchmarks, all of which lead to improved cardiovascular outcomes. Let's review the terminology necessary to use these resources effectively. It is important to understand terminology which is used frequently by NCDR. A rolling four quarters, or R4Q, represents four consecutive quarters included in the report cycle benchmark. For example, the 2019 Quarter 3 Executive Summary Measures and Metrics includes 2018 Quarter 4, 2019 Quarter 1, 2019 Quarter 2, and 2019 Quarter 3. The Q in R4Q indicates the last quarter of the rolling four quarters. The benchmark inclusion status indicates whether a submission will be included in the R4Q aggregated data or benchmark and comparison group statistics. Green, yellow, and red lights denote the submission status. My hospital R4Q represents the values for a metric or measure over a rolling four quarters of data submitted by your facility with a benchmark inclusion status of green. The all hospital 50th percentile is the median or midpoint of all participants' aggregated data for the metric or measure. Half of all participants will be above the median and half will be below. This value will correspond to the midpoint of the bullet graph. The registry aggregate is benchmarked data that includes all registry participants who have submitted complete data in a given reporting period. My hospital aggregate is the total number of patients seen or procedures performed over a R4Q period. This is adjusted for the number of quarters in which valid or green submissions were received by NCDR during the rolling four quarter period. The volume group is a grouping of sites with similar annualized procedure volumes. Volume aggregate is the total number of patients seen or procedures performed over the R4Q period within the volume group. Now let's look at a specific metric in the companion guide. In our example, we will be discussing metric nine, beta blockers prescribed at discharge. The numerator is the count of episodes or patients who meet the processes or outcomes expected for each patient, episode, or other unit of measurement defined. In this example, the numerator includes those acute MI patients who received a beta blocker at discharge. The denominator is the count of patients or episodes who remain after the denominator exceptions or exclusions are applied to the eligible metric population. In this example, the denominator includes those NSTEMI or pre-admits STEMI coded as the patient type. The denominator exclusions are those patients or episodes that are removed from the eligible metric population. In this example, the denominator exclusions include patients who received comfort measures only. Therefore, they are not required to be prescribed aspirin at discharge. As seen in this slide, there are five denominator exclusions for metric nine. Please make sure to review the executive summary measures and metrics companion guide completely when evaluating metrics. The denominator exceptions are those patients or episodes that have not met the metric numerator criteria and who have acceptable rationale for not being included if the numerator is not met. Exceptions may include a medical reason, a patient reason, or enrolled in a clinical trial which will remove the patient from the eligible metric population. Metric nine removes acute MI patients with a medical reason for not receiving a beta blocker at discharge. In this way, the metric is only considering eligible patients or episodes. The executive summary measures and metrics are selected based on supporting evidence, guideline recommendations, or expert consensus. The relevant citations will be provided for each metric as applicable. Now let's review the type of metrics and measures. They are executive metrics, quality measures, performance measures, composite metrics, and NCDR test metrics. Executive metrics are identified performance and quality metrics which have the most significant impact on patient care and have an associated patient drill down. The ACC AHA Task Force has distinguished quality measures from performance measures. Quality measures are those metrics that may be useful for local quality improvement but are not yet appropriate for public reporting or pay for performance programs. New measures are initially evaluated for potential inclusion as performance measures. In some cases, a measure is insufficiently supported by the guidelines. In other instances, when the guidelines support a measure, the writing committee may feel it is necessary to have the measure tested to identify the consequences of measure implementation. Quality measures may then be promoted to the status of performance measures as supporting evidence becomes available. Performance measures are supported by evidence, and they measure and quantify healthcare processes. They are useful for quality improvement and appropriate for public reporting or pay for performance programs. Implement metrics are a combination of several existing metrics. Some examples include metric 2, overall defect-free care for the chest pain MI registry, metric 14, ACE or ARB and beta blockers at discharge for the ICD registry, or metric 38, guideline medications prescribed at discharge for the cath PCI registry. NCDR test metrics may be new or modified in some way from an original metric. They are used to understand the current state of practice and evaluate the validity of results. This concludes Lesson 2 of Understanding Metrics, How to Use the Benchmark Companion Guide. Thank you for your participation.

Understanding Metrics

Chest Pain MI Registry

Executive Summary Measures

Metrics Companion Guide

Hospital Performance