d-ilemmas, ch-a-llenges, t-rials, a-ccomplishments (data)...d-ilemmas, ch-a-llenges, t-rials,...

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

40

60

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

3

5

8

1 0

5

2

4

0

3

5

2 2 2 2 2 2 2 2 2

0

1

2

3

4

5

6

7

8

9

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

10

20

30

40

50

60

70

80

90

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

50

60

70

80

90

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