1. ACTION Registry-GWTG New User Training Webinar February 7,2013

2. Purpose of ACTION Registry-GWTG
National surveillance system for high-risk AMI patients admitted with STEMI/NSTEMI:
Assess characteristics, treatments, and outcomes of this patient population
Optimize outcomes and management of AMI patients through implementation of ACC/AHA evidence-based guideline recommendations in clinical practice
Facilitate efforts to improve quality and safety of ACS patient care; and investigate QI methods

3. The History: ACTION Registry-GWTG
ACTION Registry transitioned from CRUSADE and NRMI Registries
January 2007 ACTION was established
May 2008 ACTION merged with AHA GWTG CAD to become
ACTION Registry-GWTG
Current membership of 800 Hospitals
500,000 records submitted
CRUSADE- How risk stratification affected outcome

4. Data Collection Options
Web-Based Data Capture
Secure, password-protected data entry system
Free NCDR data collection tool
Interoperability from Cath/PCI Registry to ACTION
Vendor-Based Data Capture
Data submitted via encrypted, password-protected file
Interoperability between ACTION and Cath/PCI Registry

5.
Participant Log In

6. The ACTION Registry-GWTG Webpage

11. Call the American Hospital Association 1-800-424-4301

14. The Dashboard eReports Comparator Standard Reports
Executive Summary Metrics
“Drill Downs”
Define peer groups
Facility attribute filters

20. Technical Data Dictionary

21. Outcomes Report Companion Guide

22. Inclusion Population Acute Myocardial Infarctions-STEMI & NSTEMI
Patient must present to 1st Facility with symptoms of ACS, within 24 hours of arrival
Patient must have positive ECG- ST elevation, new LBBB, or documented Posterior MI OR
Positive Biomarkers- Troponin or CK-MB within 24 hours of arrival
Transfer In patients- STEMI must arrive within 72 hours, NSTEMI within 24 hours
If presents with any other symptoms, or procedures, the patient is excluded

23. Choosing the Correct Form Premier Form or Limited Form
Every Hospital Has The Option To Use Either Form

24. ACTION Registry-GWTG Premier Form
Complete quarterly Outcome Report for benchmarking
Report on 17 Core Performance Measures
Report on 12 Quality Metrics
Sites are Eligible for Higher Level of Recognition Program

25. ACTION Registry-GWTG Limited Form
50% of full ACTION data set
Limited quarterly Outcome Report for benchmarking
Report on 17 Core Performance Measures
Report on 7 Quality Metrics
Lower level of Recognition

26. Limited Form: Pros and Cons
Fewer Data Elements
Less time required for
data abstraction and entry
Accommodating for Non
PCI Centers
Great form for new sites to start
Cons
No Excessive dosing
Reports for Anticoagulants
Lower Level of Recognition
Limited Quarterly Outcomes Report Not all the metrics are included

27. Premier Form: Pros and Cons
Detailed Quarterly Excessive
Dosing Reports for
Anticoagulants
Higher level of Recognition
Robust Data Set
Full Quarterly Outcomes
Report
Cons
More time required for data
abstraction and entry
Answering fields that are less
likely to pertain to Non-PCI
Centers

28. Demographics

29. Cardiac Status & History

30. Medications

31. Anticoagulants

32. Procedures

33. Reperfusion Strategy

34. Clinical Events & Biomarkers

35. Labs

36. Discharge

37. Section K- Optional Elements

38. Data Quality Reports (DQR)

39. Data Quality Reports (DQR)
A way of checking the quality of your data
It looks for data errors and completeness
Passing ensures well-formed data
Data must pass DQR to be included in the Outcomes Report
Submit as you enter data through the quarter
What is the DQR? It is a process that provides you with a data quality report. The Data Quality Report is the NCDR’s way of checking the quality of the patient data that your site has submitted. It is a series of checks that include, checking the data for errors, and assessing the completeness of the data. If your data has errors or has too many incomplete elements, then you will be required to make the corrections, and then resubmit the data until you have passed the DQR. Passing the DQR ensures well-formed data, and a statistically significant submission. Data that passes the DQR is used to create your Institutions Outcomes Report.

41. Data Assessment Results
You get to this screen. The first column is the patient ID #, then the Other ID, if you use that element in the data collection tool. The 3rd column is the patients name, and arrival date to follow. The 5th column is the Error Type, which we will go into detail about in a moment. To evaluate the error, you will read through the Description column. In the first example above, the site documented “yes” to a stent, #7105, but had entered “no” to PCI, # The patient would have had to have gone to the cath lab for a PCI, in order to have had a stent placed. You will then go into your tool, for that patient, and correct either the PCI “yes” or remove the Stent “yes”.
Clicking on the Number (#7105 in this example), is a hyperlink, and will provide you the Data Definition for that measure, to assist you in evaluating what correction is needed.

42. Failed Completeness Assessment
So for a simpler example you can see there are 3 Core Composite elements that need corrections. There are no Supporting Composites that need corrections. You can see the list of Elements that have errors that will need to be addressed. This view is set up in columns of Sequence #, the type of composite, the element name, and the break down of how many times that element should have been answered, how many times it was answered, how many times the answer was missing, then how many times the answer is required to be answered (based in the elements threshold). So for this example you can see that Hispanic or Latino Ethnicity had 5 occurrences, with none of the elements answered, the report is telling you that you must complete 4 of the 5 missing fields, which would be an 80% threshold for that individual element.

43. ACTION Registry-GWTG National Data Slide Sets Produced every 6 months

44. Use of Reperfusion Therapy for STEMI
Not Eligible for Reperfusion Therapy
Contraindication Listed
N= 2,866 (13%)
No Reperfusion –
No Contraindication Listed
N = 1272 (6%)
Primary PCI – 86%*
Fibrinolytics – 13%*
Both PCI + Lytics – 1%*
93% of eligible patients reperfused
ACTION Registry-GWTG DATA: July 1, 2008 – June 30, 2009
* Among patients receiving reperfusion

45. ACTION Door-to-Balloon Times – Median Times for Transfer In and Non-Transfer In Patients
250
240
236
230
220
223
215
212
210
200
190
180
170
169
160
158
151
156
150
Time (min)
140
130
123
120
120
116
110
103
113
102
100 96 95 90 79 80 78 75 70 74 62 60 60 57 57 50 40 30 20 10
Q1 07
Q2 07
Q3 07
Q4 07
Transfer in DTB Times
Non-Transfer in DTB Times

46. STEMI Door-to-Balloon Times – Median Times for Transfer In and Non-Transfer In Patients
250
240
230
220
210
200
190
182
180
170
165
160
157
150
150
Time (min)
140
130
130
123
120
120
117
110
100
102 88 97 96 94 90 84 82 79 80 70 70 67 66 64
D2B 20% decrease
D2B tx in 31% decrease
No one is under 90 minutes 60 50 53 52 51 50 40 30 20 10
Q1 08
Q2 08
Q3 08
Q4 08
Transfer in DTB Times
Non-Transfer in DTB Times

47. STEMI – Door to Balloon and Door to Needle Times: Cumulative 12 Month Data
ACTION Registry-GWTG DATA: July 1,2008 – June 30, 2009
DTB = 1st Door to Balloon for Primary PCI
DTN = Door to Needle for Lytics

48. NSTEMI Acute Medication Overdosing Trends
* Infusion (> 15 units/kg/hr) or bolus (> 70 units/kg)
# Initial dose (> 1.05 mg/kg) or total 24 hr dose (> 10 mg over recommended)
ACTION Registry-GWTG DATA: July 1, 2008 – June 30, 2009

49. Quarterly Outcomes Reports

50. Composite Measure

51. Composite Measure
Overall AMI Performance Graph

52. Performance Measures Acute/In-hospital Measures Aspirin Arrival
STEMI - Any reperfusion (PCI or Lytic)
STEMI - Lytic -Door to Needle (Median Time and % <30min)
STEMI - PCI – D2B (Median Time and % <90min
STEMI - D2B Transfer in (Median Time)
LVSD Evaluation
Discharge Measures
Aspirin
B-blocker
ACE or ARB (EF <40%)
Statin for LDL ≥100mg/dL
Smoking cessation (among smokers)
Cardiac rehabilitation 52 52

53. Performance Measure Graph: Aspirin at Arrival

54. Quality Metrics ACTION Metrics Door to EKG (within 10 min)
STEMI- Acute ADP Receptor Inhibitor Therapy within 24 hours of arrival_
Revascularized Patients Discharged on ADP Receptor Inhibitors
ADP Receptor Inhibitors Prescribed at Discharge for Medically Treated Patients
LDL assessment (in-hospital)
NSTEMI - Excessive Initial UFH Dosing (>70 U/kg bolus, >15 U/kg/min infusion
Excessive Initial Enoxaparin Dosing (SQ >1.05 mg/kg)
Excessive Initial GP IIb/IIIa Dosing (Full doseTirofiban if CrCl<30& Full dose Eptifibatide CrCl <50, or dialysis with either)
STEMI - Anticoagulant- UFH, enoxaparin, bivalarudin or fondaparinux (first 24 hours)
Aldosterone Blocking Agents at Discharge(EF<40%, with DM, or HF)

55. ACTION Registry-GWTG Recognition Program

56. Recognition Criteria Patient Volume
10 NSTEMI within each quarter; and/or
10 STEMI within past quarter
Must maintain uninterrupted data submission for Q1 – Q4
90% compliance

57. Recognition Thresholds
Award Levels
Must meet compliance on composite measures
Participate in
Platinum
90% compliance >= 8 consecutive quarters entering data
Premier
Gold
Premier or Limited
Silver
90% compliance >= 4 consecutive quarters entering data

58. Criteria for STEMI’s STEMI composite: ASA on Arrival
DTN<=30 minutes
DTB<=90 minutes)
discharge ASA
discharge beta-blocker,           
discharge ACE-I/ ARB (ideal patients)
discharge statin (exclude if contraindicated or LDL<100mg/dl and not discharged on statin)
smoking cessation counseling,
cardiac rehabilitation,   

59. Criteria for NSTEMI’s NSTEMI composite: ASA on Arrival discharge ASA
discharge beta-blocker                                   
discharge ACE-I/ ARB (ideal patients)
discharge statin (exclude if contraindicated or LDL<100mg/dl and not discharged on statin)            
smoking cessation counseling
cardiac rehabilitation

60. Thank you for your participation in
(800) or
Thank you for your participation in
ACTION Registry-GWTG! 60