Welcome to Lesson 3 of this learning activity titled, Understanding the LAAO Registries Follow-up Process. The content in this lesson was developed and narrated by myself. I am Fernando Garcia Barbón. Let's now go through the coding of medications during the follow-up period. Follow-up medications are captured in sequence 13-1-1-0 to 13-1-1-7 and medication changes are captured in sequence 13-1-2-0 to 13-4-15. Sequence 13-1-1-0 to 13-1-1-7 will be coded based on the medications the patient was actively taking at the time of the follow-up assessment. In this case, a 6-month follow-up is being captured and the patient was taking aspirin 325 mg as well as Plavix 75 mg at the time of the assessment. Sequence 13-1-20 to 13-4-15 will be used to capture any anticoagulation or antiplatelet medication changes that took place since the last follow-up. In this case, a 6-month follow-up is being captured. The patient's warfarin was discontinued and changed for Plavix during the patient's 45-day follow-up, which took place on February 20, 2020. Therefore, the medication change taking place during the 45-day follow-up will be captured on the 6-month follow-up. To better understand the coding of medication changes during the follow-up period, we will go through a couple of case scenarios. In our first case scenario, we have documentation on Mrs. Smith. Mrs. Smith had a successful LAAO watchman procedure on December 20, 2019. She was discharged home from the hospital on warfarin and aspirin 81 mg daily. Mrs. Smith had a follow-up TEE performed on February 5, 2020, which showed a good seal with no device margin residual leak. She was seen by the implanting physician for her 45-day follow-up on February 10, 2020. During Mrs. Smith's follow-up assessment, warfarin was discontinued. Her aspirin dosage was increased to 325 mg and Plavix 75 mg was started. During Mrs. Smith's 45-day follow-up, the assessment date will be coded as February 10, 2020 and the follow-up interval will be coded as the 45-day follow-up. When coding the follow-up medications, we have to remember we are capturing the medications which the patient was actively taken at the time of the assessment. In this case, Mrs. Smith was taken aspirin 81 mg and warfarin. When coding the follow-up anticoagulation therapy section, we are capturing any change that might have taken place from the time of the last follow-up or hospital discharge to the follow-up being coded. In this case, based on the documentation, nor warfarin nor aspirin were discontinued or held between the time of hospital discharge and the 45-day follow-up assessment. Based on this fact, we will code warfarin discontinued and resumed as no. We will also code aspirin discontinued and resumed as no. The rest of the medications will also be coded as no as they were not started or discontinued during this time window. Mrs. Smith continues to have a great recovery from her LAAO Watchman procedure. She is seen by her cardiologist in his office for her 6-month follow-up on June 10, 2020. Based on documentation, Mrs. Smith has had no adverse events or readmissions since her 45-day follow-up. During the assessment, Plavix is discontinued, but aspirin is continued with no changes to dosage. When coding Mrs. Smith's 6-month follow-up, the assessment date will be coded as June 10, 2020, and the follow-up interval will be coded as the 6-month follow-up. When coding the follow-up medications, we have to remember we are capturing the medications which the patient was actively taken at the time of the assessment. In this case, Mrs. Smith was taken aspirin 325 mg and Plavix. When coding the follow-up anticoagulation therapy section, we are capturing any change that might have taken place from the time of the last follow-up, which was the 45-day follow-up, to the follow-up being coded. In this case, based on the documentation, warfarin was discontinued during the 45-day follow-up, which will be captured by coding yes to warfarin discontinued with the date of the 45-day follow-up, which is the date in which warfarin was discontinued. Warfarin resumed will be coded as no, as based on documentation, warfarin was never resumed after being discontinued. We will also code aspirin discontinued and resumed as no. Since aspirin was never discontinued, the dosage was just changed. The rest of the medications will also be coded as no, as they were not started or discontinued during this time window. For those of us wondering when the discontinuation of Plavix will be captured, it will be captured on Mrs. Smith's 1-year follow-up. When coding the follow-up anticoagulation therapy section, discontinuation of Plavix will be coded by coding yes to P2Y12 discontinued with the date of the 6-month follow-up. If the Plavix or any other P2Y12 was not restarted, P2Y12 resumed will be coded as no. Let's look at another case scenario. In our second case scenario, we have documentation on Mr. Sanders. Mr. Sanders had a successful LAAO watchman procedure on November 15, 2019. Was discharged home from the hospital on a PIXIVAN and aspirin 81 mg daily. Two weeks post-procedure, Mr. Sanders had to be readmitted with an episode of GI bleeding. His readmission date was November 28, 2019. During the hospitalization, Mr. Sanders received two units of PACREB blood cells and his PIXIVAN was held from November 28 to December 2, 2019. He was seen by the implanting physician for his 45-day follow-up on December 21, 2019. During Mr. Sanders' follow-up assessment, a PIXIVAN was discontinued. Aspirin dosage was increased to 325 mg and Plavix 75 mg was started. Coding Mr. Sanders' 45-day follow-up, assessment date will be coded as December 21, 2019. The follow-up interval will be coded as the 45-day follow-up. When coding the follow-up medications, we have to remember we are capturing the medications which the patient was actively taken at the time of the assessment. In this case, Mr. Sanders was taken aspirin 81 mg and a PIXIVAN. Coding the follow-up anticoagulation therapy section, we are capturing any change that might have taken place from the time of the last follow-up or hospital discharge to the follow-up being coded. In this case, based on documentation and the patient's GI bleeding event, a PIXIVAN, which is a DOAC medication, was discontinued on November 28 and restarted on December 2, 2019. Based on this knowledge, we will code DOAC discontinued as yes, with the date in which it was stopped. DOAC resumed as yes, also with the date in which it was resumed or restarted. Note, if the medication was never restarted, this would be coded as no. We will code aspirin discontinued and resumed as no, since based on the documentation, aspirin was never discontinued or held. The rest of the medications will also be coded as no, as they were not started or discontinued during this time window. Follow-ups are also measured in metrics. The follow-up metrics provided to participating hospitals, based on their submitted data, are divided into quality and informational metrics. The timing of when the follow-up data were submitted may impact the metric, depending on what the unique metric is reporting. As you review your metrics, some of the metrics will include patients who had their follow-up assessment performed within the registry recommended time window. Other metrics will include patients who had their follow-up assessment performed at any point outside of the recommended time window. And others will include performance based on follow-up data captured at any time during the entire follow-up window. This includes the registry recommended time window, as well as anything outside of that window. When reviewing your follow-up metrics, it is good to note that reading the metric description will indicate which follow-ups are included in the metric. For example, metric 211 will include all procedures in the denominator that were eligible for a follow-up. Metric 200, as described, will only include procedures where the patient had a 45-day follow-up performed within the registry recommended time window. And metric 202, 203, and 204 will include procedures where the patient had an event from the procedure date through the follow-up insight window. In this case, since these are 45-day follow-up metrics, it's day 59 post-procedure. Please take advantage of the resources available in the registry's homepage. For detailed information of all follow-up timeframes and date ranges, please download the follow-up timeframe guide document. The document is located under the Resources tab and Documents. The document is part of the version 1.3 data collection documents and is available for download. This presentation, as well as many others, will also be available to review at your convenience on the Quality Improvement for Institutions or QII Learning Center, which is located under the Resources tab as well. There are also tools and ways to track patients during the follow-up period. The first are ways to confirm if a patient has had a follow-up entered in the system. To use this functionality, we must access the data collection tool. The data collection tool is accessed through the Data tab. Once in the data collection tool, we will choose Follow-up Search and Edit from the menu. Once in the follow-up management page, you may search for a specific patient by entering any of their identifiers and clicking on the Search tab. The system also allows to search using date ranges. You may use the procedure date as well as follow-up date ranges. When a date range has been entered, the system will display the patients who had a procedure or a follow-up entered within the date range. You may also enter a date range and search which patients do not have a follow-up entered by selecting No follow-up. Follow-ups within a specific quarter can be searched by clicking on the follow-up time frame drop-down menu and selecting a specific quarter. Several participants have shared tracking tools that have been successful in keeping track of their patients during the follow-up process. These tools are available to all participants on the Participant Resource Sharing functionality. The Participant Sharing functionality is located under the Resources tab and Participant Resource Sharing. At this time, there are two follow-up tools that have been shared by registry participants. If you are a registry participant that has developed a useful tool or process to help the follow-up process and would like to share with the registry community, please click on the hyperlinks located in the webpage to access the instructions as well as the user agreement. Here are several tips to have a successful follow-up process. If there is an LAAO coordinator in your facility, ensure collaboration to align pre-procedure and follow-up processes. Interaction on follow-up process with clinicians and representatives is very important. Utilize a tracker-type document, such as the one under Participant Resource Sharing, and share in a location where the whole team can access. Review the follow-up plan with the patient as part of their discharge instructions. Set up a 45-day TEE and office visit as part of discharge, and explore utilizing a phone call for follow-up information as applicable based on clinician and patient agreement. This concludes Part 3 of 3 of Understanding the LAAO Registry Follow-up Process. Thank you for your participation.

LAAO Registries

follow-up process

medication coding

case scenarios

follow-up metrics