VK aren Alexander Cardiosource and NCDR by V8OKI3ub


									Cardiosource/NCDR Integration
“The Trusted Source at your Fingertips”

              Karen P. Alexander MD, FACC
           Associate Professor, Duke University
             Duke Clinical Research Institute

        DISCLOSURE: No Relationships to Disclose

•   Integration
•   Purpose and Goals
•   Registry Pages
•   Future Directions
•   Feedback
        Mission of the NCDR™

To improve the quality of cardiovascular patient
    care by
   providing information, knowledge and tools
   implementing quality initiatives
   supporting research that improves patient care
    and outcomes

   #1 Educational Resource for CV Providers
   Bring all the pieces together
    – Guidelines, Trials, Recent News, CME, ME, QI and
   A trusted source of information
   Uniquely positioned to keep pace with NCDR
         Purpose of Integration

   Demonstrate the strengths of NCDR to the
    broader audience
    – Deliver messages from the wealth of NCDR data
    – Encourage new site participation
   Enhance experience of existing NCDR sites
    – Capitalize on strengths of Cardiosource
   Bridge the gap between guidelines and practice
    – Sharing practical approaches and solutions
            Site Comparisons
               accncdr.com           cardiosource.com
Audience      NCDR Participants        Cardiology Providers

Purpose           Operational               Educational

Content      Definitions, EDC, DCF   News, Publications, Tools,
                                     Links, Case Studies, CVN

Focus           Registry Work            Registry Message

Strengths      Data acquisition               Visibility
             Organization, Details           Education

Page views             -                   1.8 million/mo
               Registry Facts

   Overview of Registry
    – Describe registry partnerships, history, reports
    – Registry Population
       • Entry criteria
    – Method of Data Collection
       • Links to DCF on NCDR pages
    – Contacts
              Site Participation Maps
ACTION RegistryTM Number of Participating Institutions
           ACS Guidelines Focus Centers

•   Jan 15, 2008 2007 Focused Update of the ACC/AHA 2004 Guidelines for
    the Management of Patients With ST-Elevation Myocardial Infarction
•   Aug 14, 2007 Full Text ACC/AHA 2007 Guidelines for the Management of
    Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction
•   Aug 4, 2004 Executive Summary of the 2004 Guidelines for the
    Management of Patients With STEMI
           ACTION Quality Tools Button

•   TIMI STEMI Score
•   GRACE 30d and 6 mo Mortality Model
•   Cockroft-Gault Creatinine Clearance Calculator
•   CRUSADE Bleeding Risk Score (coming soon)
             Editor's Choice

•   Mar 3, 2008 Incidence of Death and MI with stopping Clopidogrel after
    Acute Coronary Syndromes
•   Feb 25, 2008 Implementation of a State wide system for Coronary
    Reperfusion in STEMI
•   Feb 25, 2008 Regional Variation in Cardiac Catheterization
    Appropriateness and Baseline Risk after Acute MI
•   Jan 29, 2008 Clopidogrel Desensitization After Drug-Eluting Stent
•   Mar 1, 2006 ACTION Registry Quick Facts
             Journal Articles/Abstracts

•   Feb 25, 2008 The Role of Fondaparinux as an adjunct to thrombolytic
    therapy in acute MI. A Subgroup Analysis of the OASIS 6 Trial
•   Feb 1, 2008 The Year in Non–ST-Segment Elevation Acute Coronary
•   Jan 23, 2008 Patterns and Implications of B-Type Natriuretic Peptide
    Measurement in Patients With Non–ST-Segment Elevation Acute Coronary
    Syndromes (Am J Cardiol)
•   Jan 11, 2008 A Framework for Quality Improvement: An Analysis of
    Factors Responsible for Improvement at Hospitals Participating in the Can
    Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse
    Outcomes With Early Implementation of the ACC/AHA Guidelines
    (CRUSADE) Quality Improvement Initiative (Am Heart J)
ACTION Dosing Guides, Templates
                 Guideline Case Studies

•   Feb 22, 2008 An 80-Year-Old Woman Scheduled to Undergo Left Hip
    Replacement Presents to the ER With 1 Hour of Ongoing Chest Discomfort
•   Nov 19, 2007 Guideline Case Study: A 48-Year-Old Female Smoker
    Presents With Subxiphoid Burning, Dyspnea, and Diaphoresis
•   Nov 19, 2007 Guideline Case Study: A 60-Year-Old Hypertensive Diabetic
    Male Presents to the ER With 30 Minutes of Squeezing Substernal Chest
              Site Enrollment Maps
ICD RegistryTM Number of Participating Institutions
Links to Society Partners
            ICD Devices Button

   Links
    – ICD security and privacy properties
    – FDA Manufactures and User Facilities Device
      Evaluation Database (MAUDE)
    – Device Advisories-Medtronic
    – Consumer protection with implanted devices-leads
                 Future: QI Case Studies

QI Case Studies
                                             STEMI and NSTEMI Dosing Errors
                                      STEMI Report (N=79 pts) Q3 2007
Metric and Site Reports
Site Interview
  How did you identify the problem?
  What did you do to understand it?
  Did you change your processes?      NSTEMI Report (N=115 pts) Q3 2007

  How are things going now?

        Future Directions: Dashboard
 STEMI – Door to Balloon and Door to Needle
     Times: Cumulative 12-Month Data
        ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)





      DTB <= 90 min -      DTB <= 90 min -      DTN <= 30 min - All
      Non-Transfer In        Transfer In
                                                          DTB = 1st Door to Balloon for Primary PCI
                                                          DTN = Door to Needle for Lytics
         Future Directions

 QI Communities
 Site Recognitions
    – Gold Circle by Participation or Scores
   Other Ideas?

   Each NCDR registry will have its own page
    – Similarities in maps, facts, publications, guidelines
    – Unique content
   NCDR community: Audience
    – Literature, Guidelines, Order sets, Links
    – Tools
   NCDR community: Authors
    – QI Communities, QI case studies, Talk back,
    – Data and Publications
            Cardiosource/NCDR Team
Registry      Team Leader                   Associate Directors

ACTION        Karen Alexander (Duke)        Joe Lynch

CathPCI       Robert Piana (Vanderbilt)     Tony Hermann

ICD           Mark Kremers (Mid Carolina)   Christine Lang

CARE          Michael Jaff (Mass General)   Sari Caldwell

IC3                TBD                      Kristi Mitchell

NCDR Communications                         Leslie Edsall
Assoc. Editor/NCDR, Cardiosource            Karen Alexander MD
Editor-in-Chief, Cardiosource               Chris Cannon MD
Managing Editor, Cardiosource               Kate Goettge

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