ACTION Registry-GWTG
New User Training Webinar
February 7,2013
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
The History: ACTION RegistryGWTG
• 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
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
www.ncdr.com
Participant Log In
The ACTION Registry-GWTG Webpage
Call the American Hospital Association
1-800-424-4301
The Dashboard
• eReports
• Comparator
Dashboard
eReports
Comparator
• Standard Reports
• Executive
Summary Metrics
• “Drill Downs”
• Define peer
groups
• Facility attribute
filters
Technical Data Dictionary
Outcomes Report Companion Guide
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
Choosing the Correct Form
Premier Form or Limited Form
Every Hospital Has The Option
To Use Either Form
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
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
Limited Form: Pros and Cons
Pros
Cons
Fewer Data Elements
No Excessive dosing
Reports for Anticoagulants
Less time required for
data abstraction and entry
Lower Level of Recognition
Accommodating for Non
PCI Centers
Limited Quarterly Outcomes
Report Not all the metrics are
included
Great form for new sites to
start
Premier Form: Pros and Cons
Pros
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
Demographics
Cardiac Status & History
Medications
Anticoagulants
Procedures
Reperfusion Strategy
Clinical Events & Biomarkers
Labs
Discharge
Section K- Optional Elements
Data Quality Reports
(DQR)
Data Assessment Results
Failed Completeness Assessment
ACTION Registry-GWTG
National Data Slide Sets
Produced every 6 months
Use of Reperfusion Therapy for STEMI
STEMI
N = 21,978
Reperfusion
Not Eligible for
Reperfusion Therapy
N = 17,711 (81%)
No Reperfusion –
Contraindication Listed
N= 2,866 (13%)
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
Time (min)
ACTION Door-to-Balloon Times –
Median Times for Transfer In and Non-Transfer In Patients
250
240
230
220
210
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
236
169
123
223
215
212
158
151
156
116
113
120
103
79
62
Q1 07
102
78
60
Q2 07
Transfer in DTB Times
96
95
75
57
74
Q3 07
57
Q4 07
Non-Transfer in DTB Times
STEMI Door-to-Balloon Times –
Time (min)
Median Times for Transfer In and Non-Transfer In Patients
250
240
230
220
210
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
182
165
130
102
123
88
97
84
157
150
120
117
96
82
94
79
70
67
66
64
53
52
51
50
Q1 08
Q2 08
Transfer in DTB Times
Q3 08
Q4 08
Non-Transfer in DTB Times
STEMI – Door to Balloon and Door to Needle Times:
Cumulative 12 Month Data
100%
87%
80%
67%
60%
40%
20%
20%
0%
DTB <= 90 min Non-Transfer In
DTB <= 90 min Transfer In
DTN <= 30 min - All
ACTION Registry-GWTG DATA: July 1,2008 – June 30, 2009
DTB = 1st Door to Balloon for Primary PCI
DTN = Door to Needle for Lytics
NSTEMI Acute Medication Overdosing Trends
30%
25%
20%
UFH*
15%
LMWH#
GP Iib-IIIa
10%
5%
0%
* 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)
Q3 2008
Q4 2008
Q1 2009
Q2 2009
ACTION Registry-GWTG DATA: July 1, 2008 – June 30, 2009
Quarterly Outcomes Reports
Composite Measure
Composite Measure
Overall AMI Performance Graph
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
Performance Measure Graph:
Aspirin at Arrival
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)
ACTION Registry-GWTG
Recognition Program
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
Recognition Thresholds
Must meet compliance on
composite measures
Participate in
Platinum
90% compliance
>= 8 consecutive quarters
entering data
Premier
Gold
90% compliance
>= 8 consecutive quarters
entering data
Premier or Limited
Silver
90% compliance
>= 4 consecutive quarters
entering data
Premier or Limited
Award Levels
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,
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
(800) 257-4737 or email ncdr@acc.org
Thank you for your participation in
ACTION Registry-GWTG!