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Overview on Project and Data Quality

Dallas County STEMI Market Performance Data – Analytics – Q4 2010 Jim Langabeer II, PhD Center for Emergency Research University of Texas Health Science Center. Overview on Project and Data Quality . Project Structure. American Heart Association. Communities Foundation of Texas.

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Overview on Project and Data Quality

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  1. Dallas County STEMI Market PerformanceData – Analytics – Q4 2010Jim Langabeer II, PhDCenter for Emergency ResearchUniversity of Texas Health Science Center

  2. Overview on Project and Data Quality

  3. Project Structure American Heart Association Communities Foundation of Texas AHA Caruth AMI System Initiative UT Health Science Center Houston AHA Caruth Volunteer Advisory Board James Langabeer UT Southwestern Dallas Dallas Stakeholder Committee Raymond Fowler Michael Taylor American College of Cardiology Education Subcommittee Karen Pickard Chris Weinzapfel EMS Resources Subcommittee Kevin Cunningham Craig White Protocols Subcommittee Chris Chiara Mark Till Symposium Planning Subcommittee Jon Gardner Tami Kayea Jennifer Ledbetter Quality Improvement Subcommittee Bob Hillert Tom Tierney

  4. UT Health - Role • Data collection from ACC & EMS • Development of a central database • Comparison of EMS to hospital patient records • Data validation/integrity checks • Decision Support (data analysis) of STEMI outcomes

  5. Dallas Hospital Market • This is the inaugural report of the Dallas County STEMI system of care • Use caution when interpreting these figures since they are strictly baseline for everybody involved! • Data are for Oct 1 2010 to Dec 31 2010 • Data collected from EMS agencies and hospitals (through ACC Action Registry GWTG)

  6. Overview to Methodology • Our primary focus is on collecting and analyzing both pre-hospital (EMS) and hospital data for STEMI/NSTEMI in Dallas County • To capture SOAR, we prefer to have complete records from time of 911 dispatch to hospital discharge • We need to match EMS Hospital data, preferably using PCR or Incident # • For this quarter, we had to use DOB and incident date/hospital arrival date since Aux3 field was not widely populated

  7. Overall Data Quality - Reminders • This project requires good data entry from both EMS & hospitals! • We cannot identify if 10-key entry errors exist • Lots of “null values”; for instance, several patients had PCI=yes, but were missing device times or dates • EMS: arrival times at facility missing in many cases • 24 hour time clock (e.g., 6 pm = 18:00)

  8. Reporting Agencies Summary

  9. Comment on EMS Data • Overall, we were not able to provide meaningful data analyses on most of the EMS data for Q4 due to • Missing data • Data quality, • Issues in EMS reporting • Data timing and integrity issues • We expect to have this resolved for Q1 2011

  10. Patient Population Q4 2010

  11. Q4 2010 Patient Volumes • 603 admissions in the NCDR/ACC registry • 594 unique patients • 15 participating hospitals • (we’ve received data for 14 this quarter) • 203 STEMIs noted (34% of all registry cases) • 129 STEMI, PCI, non-transfer cases in total • 123 Primary PCI form the population for all D2B and other timing outcomes

  12. Patient Breakdown for Outcome Calculations Total Cases 603 STEMI Noted 203 NSTEMI 400 To Cath. Lab 167 (82% of STEMI) No PCI 36

  13. Patient Demographics Figures rounded for presentation purposes

  14. STEMI Patient Volumes

  15. Transfer Patients – STEMI PCI Only

  16. STEMI Key Outcome Metrics 1 1 non-transfer, STEMI, primary PCI only

  17. SOAR Analysis – Q4 2010Median time in Minutes

  18. SOAR (Symptom Onset to Reperfusion)STEMI, Primary PCI, Non-Transfer H12 H7 H11 H14 H1 H8 Median H5 H6 H4 TARGET H3 H10 H13 H2

  19. SOARSTEMI, Non-Transfer, Primary PCI Only% of Cases in Each time category (n=121 complete)

  20. Door to Balloon Times STEMI, Primary PCI only, Non-Transfers 1 Median

  21. STEMI – Dallas County D2B Outcomes Primary PCI, Non-Transfer Only Most Consistently Low D2B (with least variability)

  22. D2B Outcomes by Hospital Complete Cases Only (STEMI, Non-transfer, primary PCI only); 129 STEMI-PCI, 123 immediate PCI, 2 missing data) Data witheld on cases for confidentiality purposes

  23. D2B Times STEMI, Non-Transfer, Primary PCI Only% of Cases in Each time category (n=121 complete)

  24. STEMI Outcomes • The shortest D2B time was 23 Minutes • Average length of stay for all STEMI (non-transfer, primary PCI) patients was 3.6 days • We had 9 deaths in the STEMI population (4.4%)

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