APPROPRIATE USE CRITERIA (AUC) FOR CORONARY REVASCULARIZATION
UTILIZING CASES SUBMITTED TO THE NCDR® (National Cardiovascular Data
Registry) CATHPCI REGISTRY®
*Carole Salamah, RN, ADN, Data Outcomes Specialist; *Jean Fleming, RN, BSBA, Health Care Improvement Coordinator; *Cecilia Lijauco, RN, MSN, Director of Health Care Improvement and Care Coordination; *Edward
Bond, PhD, Database Analyst, Baylor Information Services (BIS); *Nancy Vish, RN, PhD, NEA-BC, FACHE, President and CNO; *Robert Stoler, MD, FACC, FSCAI, Director of the Cardiac Catheterization Lab
Baylor Jack and Jane Hamilton Heart and Vascular Hospital (BHVH), Dallas, Texas
Background
Article published in Journal of The American
College of Cardiology (JACC) (1) regarding
Appropriateness Criteria for Coronary
Revascularization of about 180 frequent scenarios
that were graded for appropriateness by a panel of
physicians and surgeons.
1. Manesh R. Patel, Gregory J. Dehmer, John W. Hirshfeld,
Peter K. Smith, and John A. Spertus
ACCF/SCAI/STS/AATS/AHA/ASNC 2009
Appropriateness Criteria for Coronary
Revascularization: A Report by the American College of
Cardiology Foundation Appropriateness Criteria Task
Force, Society for Cardiovascular Angiography and
Interventions, Society of Thoracic Surgeons, American
Association for Thoracic Surgery, American Heart
Association, and the American Society of Nuclear
Cardiology Endorsed by the American Society of
Echocardiography, the Heart Failure Society of America,
and the Society of Cardiovascular Computed Tomography
J. Am. Coll. Cardiol. 53: 530-553.
BAYLOR HAMILTON HEART AND
VASCULAR HOSPITAL OVERVIEW
Part of the Baylor Health Care System
Joint Venture
Connected to Baylor University Medical Center
Magnet Designation 2007
Total admissions for 2010 - 22,469
CathPCI Registry® submissions 2010 - 3700
With - 1600 PCI procedures
ICD RegistryTM submissions 2010 - 470
ACTION Registry®–GWTGTM submissions
2010 - 400
ADD OTHER HOSPITAL/ORGANIZATION LOGOS HERE
Objectives
*No conflicts to disclose
Physician Progress Record
Design and implement a method at BHVH that
identifies “inappropriate” percutaneous coronary
intervention (PCI) procedure based on the criteria
presented in the JACC article and review the
cases that are identified
Method
•Multidisciplinary team formed
•Physician Champions
•Healthcare Improvement
•ACC Data Analyst
•Apollo/Lumedx Systems ® Administrator
•Utilize current PCI data from software to
abstract cases meeting the “inappropriate criteria
based on JACC article
•Educated Interventionalists on JACC article and
posted tables in physician dictation area for
review
•Case review by the Medical Director of the Cath
Lab: 8% of total PCI cases. After review, none
required presentation to Cardiology Peer Review
Committee
•ACC generated AUC Beta Report reviewed and
presented to Medical Leadership
•Physician Progress Record updated for ease of
documentation
JACC Appropriateness Figures 2, 3 and 4
Conclusion
Physician Education
Documentation for ACC elements will
continue to be monitored and physicians
trained
Self Auditing
Continue to monitor via self audits for
“Inappropriate” categories with Director of
Cath Lab
ACC Appropriate Use Criteria (AUC)
When available in 4th quarter 2010, will
utilize the ACC outcomes report for
Cardiology Peer Review (concentrating on the
“inappropriate” category – to keep low)
Present Executive Outcomes report from
ACC to the Leadership and Physician
Cardiology Committees