d-ilemmas, ch-a-llenges, t-rials, a-ccomplishments (data)...d-ilemmas, ch-a-llenges, t-rials,...
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RESEARCH POSTER PRESENTATION DESIGN © 2015
www.PosterPresentations.com
Benefits for Cone Health Joining the PVI RegistryWhen there was a sharp increase in bleeds and
complications Q3 at Cone Health , it was
quickly noted and all cases were reviewed by
the team for trends. During the review no trends
were found.
Wanda Shelton RN,BC BSN
D-ilemmas, ch-A-llenges, T-rials, A-ccomplishments (DATA)
Cone Health Quality Dept.
Introduction
The Peripheral Vascular Interventions Registry Health care has evolved into something that most of us would
not have thought possible before. With the rising cost of health
care in America, the current economy, and our movement
towards globalization in the health care industry, following best
evidence based practices is very important. Cone Health’s
voluntary participation will continue to ensure that we are top
performers in providing care to the peripheral vascular disease
patient population.
Triggers By Numbers▪ Affects 10-12 million Americans
▪ 200 million have PAD globally
▪ 75% unaware of PAD risk
▪ 1 out of 3 diabetics have PAD
▪ African-Americans 2X more likely to develop PAD
▪ Smokers have a 4x greater risk of developing PAD
▪ Those who have a hx of MI or stroke have a 3x
greater chance of developing PAD
▪ 70% of PCPs unaware of the presence of PAD in
their patients
▪ 50% of patients who have PAD and require a LE
amputation – die within 5 years of losing the limb
▪ By 2024 vascular disease will claim the lives of 2
million Americans each yearDr. Muhammed Arida (PVI Registry Champion)
Cheryl Booth Karen Bartles Angela Moore Rebekah MyersDr. Christopher Dickson Mary Godley Vangela Swafford Donna McCoy Dr. Vance Brabham Dr. Gregory Schnier Laurie Freeman Dr. Jonathan Berry Dr. Jason Dew Sarah Lackey RN Dr. Jagadeesh Ganji ARMC Cath Lab Team Edward DonnaldJohn Dixon ARMC IR Team Teresa SchraderRodney Cox Edith Apple RN Abbie SamuelCone Cath Lab Team Jackie Mullins Julie McBride
Acknowledgements
• Deepak L. Bhatt, MD, MPH, FACC, FAHA et al; Journal of the American College of Cardiology,
ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement
Enterprise, A Report of the American College of Cardiology/American Heart Association Task
Force on Performance Measures and The Society of Thoracic Surgeons, vol. 66 no. 20 2230-
2245, http://dx.doi.org/10.1016/j.jacc.2015.07.010
• National Cardiovascular Data Registry Website,
https://www.ncdr.com/webncdr/home/registry-selection
• American College of Cardiology website, Tools and Practice Support, www.acc.org.
• Rooke TW, et al. 2011 ACCF/AHA Focused update of the guidelines for management of patient
with peripheral artery disease. J Am Coll Cardiol, 58919): 2020-2045
• Olin JW, Allie DE, Belkin M, et al. 2010 Performance Measures for Adults with Peripheral Artery
Diseases: A Report of the ACC Foundation/AHA Task Force on Performance Measures. J Am Coll
Cardiol. 2010;56(25):2147-2181. doi:10.1016/j.jacc.2010.08.6 06.
• Facts About Peripheral Arterial Disease, Aug 2006, NIH Publication No 06-5837,
www.PADcoalition.org
• Peripheral Arterial Disease (PAD) Fact Sheet, June 16, 2016.
https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_pad.htm.
• Criqqui, Michael H Aboyans, Victor. Epidemiology of Peripheral Artery Disease, Circulation
Research April 23, 2015; http://circres.ahajournals.org/content/116/9/1509
• Tsai, Thomas T, MD, MSc, The NCDRs PVI Registry Improving Quality for PVD Patients,
CardioSource WorldNews Interventions. Sept, 2014; http://www.acc.org/latest-in-
cardiology/articles/2014/05/22/14/43/peripheral-matters
• Improving Vascular Disease Prevention, Detection and Treatment; A Conference Report from the
American Heart Association Vascular Disease Thought Leaders Summit, Aug. 20, 2015
Conclusion and Nursing Implications
The PVI Registry is just a small piece of the registry world. As
nurses, we have an obligation to educate our patients on the risks of
developing PAD. Also as nurses, we have an obligation to
understand the implication of data collection and how it is used. As
we go forward, healthcare is moving away from pay for service
models and toward pay for performance models. Data, such as that
being collected through registries and core measures, is one way of
proving that patients are getting the best care available. It also
provides a method to improve patient care and patient outcomes.
Good clean data is dependent upon complete and accurate
documentation. With public reporting, it will become imperative that
our data is as good as, or better than, that of our competition. We
provide great care to our patients, and our documentation needs to
reflect that; then our data will prove it!
Comparing Recommendation to Results
• Resting ABIs should be reported as abnormal (ABI ≤ 0.90), borderline
(ABI 0.91-0.99), normal (1.0-1.4) or noncompressible (ABI > 1.4)
• Resting ABIs are recommended in patients with a history or physical
examination suggestive of PAD, with or without segmental pressures or
waveforms.
• In patients at increased risk of PAD but without history or physical
examination findings suggestive of PAD, a measurement of resting ABI is
reasonable.
• Patients not at increased risk for PAD, and without history or physical
examination findings suggestive of PAD, the ABI is NOT recommended.
We soon discovered that although both Cone and
ARMC appeared to be technically successful, the
documentation was not adequate to use in the PVI
Registry. Words like “widely patent”, and “successful”
could not be translated into percentages. So our early
technical success scores were low! NCDR’s crosswalk
did not work for us, but we were allowed to create our
own crosswalk if all of the vascular team would agree
on the wording.
Problem Recommendation
Solution
0
20
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80
100
Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17
Technical Success
Cone ARMC National
Results
Using the Data to Spot Trends
3
4
2
7
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1 0
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0
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2 2 2 2 2 2 2 2 2
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Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17
Bleed or Major Vascular Complications
Cone ARMC National
A decline in P/O antiplatelet orders at ARMC was found to
be a EMR glitch
9188
9498
9590
93 94 93
75
8589
78
58
8580
85
95 95 96 96 97 97 97 97 96
0
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100
Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17
Antiplatlet Therapy Ordered at D/C
Cone ARMC National
ACC recommends all PAD patients be on a statin at
discharge, but his has not become a national trend.
0
10
20
30
40
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60
70
80
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100
Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17
Statins ordered at D/C
Cone ARMC National
▪ Assesses the demographic, prevalence, provider and facility
characteristics.
▪ Provides benchmarked decision making data on endovascular
techniques and treatments
▪ Supplies outcome-based evidence for new treatments and
medications
▪ Provides reports that compare our institutions performance
with peer groups throughout the nation using the latest
evidence based guideline.
▪ Promotes meaningful quality improvement opportunities
▪ Provides executive summaries that give a big picture review of
quality data and provides for individual patient level drill
downs.
• Launched by American College of
Cardiology in 2014
• The National Cardiology Data Registry is
the data warehouse for the PVI Registry
• Purpose is to address transition from
open surgical model to percutaneous for
peripheral vascular
• disease (PVD) treatment
• Registry assess prevalence,
demographics, treatment and outcomes of
patients with PVD
• Enable physicians (MDs), hospitals,
Centers for Medicare and Medicaid (CMS)
and Federal
• Drug Administration (FDA) to monitor
safety and effectiveness of
revascularization modalities.
• Helps meet future demands of public
reporting and appropriate use criteria for
PVD patients
PVI Registry Objectives
Method/Data Collection:
Retrospective Chart Review
▪ Medical History and Physical: nursing notes. doctors
dictation, Care Everywhere, progress notes
▪ Pre-procedure Assessment: office documents, scanned
documents, labs, radiology, vascular studies, wound center info
▪ Procedure: cath lab, OR, interventional radiology
▪ Complications: during procedure, post procedure, 30 days, 1
year follow-ups
ABI is an abbreviation for ankle-brachial index and is an objective measurement of arterial insufficiency based on the ratio of ankle systolic pressure to brachial systolic pressure.
References