Michael A. Kutcher MD, FSCAI; John C. Messenger MD, FSCAI; Henry S. Jennings III MD, FSCAI

Background

The American College of Cardiology (ACC) established the National Cardiovascular Data Registry (NCDR) CathPCI Registry in 1998 to collect comprehensive clinical, process, and outcome measures on patients undergoing diagnostic cardiac catheterization and percutaneous coronary intervention (PCI) {1}. Numerous data element versions evolved. Version 4 was implemented in 2009. Version 5 was recently developed to remove unimportant elements, include more relevant metrics, and collect critical elements necessary for the most recent appropriate use criteria (AUC).

The last CathPCI Registry submission based on Version 4.4 ended in the 2nd quarter of 2018. The last Institutional Outcomes Report based on Version 4.4 will come out by the end of 2018. Version 5 data collection started in July 2018. Institutions are currently submitting for the 3rd quarter of 2018. The Institutional Outcomes Report reflecting Version 5 metrics will come out in early 2019. As with any new data version, there will be issues of implementation, submission, and assessment of data. When one considers the voluntary data modules in Version 5, the number of data elements is essentially unchanged.

Key Added Metrics

  • Details about the timing and type of mechanical support devices
  • Cumulative air kerma as a patient radiation-exposure parameter
  • Surgical turndown and patient refusal for surgery
  • Frailty assessment
  • Hypothermia details and timing
  • Details of out-of-hospital cardiac arrest
  • Assessment of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in all scenarios to identify ischemia-producing lesions and to support AUC for PCI

Data Collection Form v5.0

The form consists of 14 pages. Basic categorization is divided into pre-procedure, procedure, post-procedure, and 30-day and one-year follow-up (optional). A full copy of the 14-page Data Collection Form v5.0 is available here (pdf file). A full copy of the 242-page Data Dictionary v5.0 is available here (pdf file).

How to Be Proactive

  • Review and become familiar with the Data Collection Form v5.0. It is important that you or a group of your colleagues serve as “data champions” for your institution and your practice.
  • Meet with your data coordinators on a regular basis. Listen to their concerns about data abstraction and how this can be improved.
  • For pre-procedure data, in today’s era of electronic health records (EHRs), it should be possible for you and your colleagues to agree on a template note entered in the medical record to cover metrics that can be more easily abstracted into the CathPCI Registry.
  • Regarding procedure data, conduct an extensive assessment of your EHR or CathPCI report-generating system. Assess the best way of capturing version 5 metrics to be downloaded directly into the CathPCI Registry submission form. If you already have a structured CathPCI report system {2}, this should be easier.
  • For post-procedure data, again try to agree on a template to capture these elements. This could be filled in by the discharge nurse or data coordinators and be part of the medical record. It would then be easier to abstract this data for submission.
  • Be friends with your information technology (IT) team. Work with IT and your EHR vendor to develop these data templates. Meet with IT and your data coordinators on a monthly basis to smooth out problems or issues. Above all, if data elements could be mapped directly into the CathPCI submission form, that would make the process more accurate and time efficient.

Importance of the CATHPCI Registry for Quality Improvement

There are great organizational manpower stresses and institutional concerns about the economic value of participating in the NCDR CathPCI Registry. There is a perception that registries serve as a money-making proposition for the sponsoring organization and a vehicle for academic publications by a small elite group. Points to make:

  • Databases are imperfect, but this is a well-established clinical database instead of a government or healthcare vendor-billing database. We as cardiologists have control over this.
  • In the era of expanding third-party payer initiatives of “pay for performance,” the downside of abandoning the NCDR CathPCI Registry is economically shortsighted.
  • All participant institutions and physicians are invited to submit data analysis proposals to the Research and Publications Subcommittee, which meets on a quarterly basis to formally review requests and prioritize projects. Link: https://cvquality.acc.org/NCDR-Home/research/submit-a-proposal/Steps-for-Submitting-a-Proposal
  • The addition of more detailed data regarding issues such as out-of-hospital cardiac arrest, hypothermia, and hemodynamic support systems will add contemporary information to the appropriate management of these complex patients.
  • The advantage of national benchmarks for institutions and individual operators results in the better identification of outliers (both positive and negative) to improve systems process and outcomes in patients.
  • The CathPCI Registry is a powerful tool for institutional quality improvement (QI) projects. Data should be reviewed by a QI committee on at least a quarterly basis to assess opportunities for improvement to impact better patient care.

 

BIBLIOGRAPHY

  1. Brindis RG, Fitzgerald S, Anderson HV, Shaw RE, Weintraub WS, Williams JF. The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR): building a national clinical data repository. J Am Coll Cardiol 2001;37:2240-5.
  2. Sanborn TA, Tcheng JE, Anderson HV, et al. ACC/AHA/SCAI 2014 health policy statement on structured reporting for the cardiac catheterization laboratory: a report of the American College of Cardiology Clinical Quality Committee. J Am Coll Cardiol 2014;63:2591–623.

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