Current CED Data Sources

1. l CED Data SourcesAHRQ Annual ConferenceSeptember 2010 James A Rollins, MD, MSHA, PhDCoverage and Analysis GroupOffice of Clinical Standards and QualityCenters for Medicare & Medicaid Services

2. Current CED Data Sources • ICD Registry Created by the American College of Cardiology Foundation • NOPR National Oncologic PET Registry

3. ICD Registry and Variables Collected • Demographic information Name SSN Patient ID Date of Birth Race Ethnicity Gender

4. History of Risk Factors • History of Heart Failure • Duration of Symptoms • Prior hospitalization for HFM, Timeframe • NYHA Functional Classification • Prior Heart Transplant • Non-Ischemic Dilated Cardiomyopathy Timeframe • Syncope, Family Hx of Sudden Death

5. History and Risk Factors (cont.) • On Transplant Waiting List • Atrial Fibrillation/Flutter • Ventricular Tachycardia (Hemodynamic instability) • Cardiac Arrest • Syndrome w/Risk of sudden death • Previous ICD (date, implant site, reason, primary or secondary prevention

6. History and Risk Factors (cont.) • Ischemic Heart Disease • Prior MI • Prior PCI • Prior CABG

7. Diagnostic Studies • LVEF Assessed • Electrophysiologic Study (study timeframe, ventricular arrhythmias induced, VT ablation performed, EP study findings) • Lead ECG w/Automated Measurements • PR interval • QRS duration

8. Diagnostic Studies • Cardiac Rhythms • Abnormal Intraventricular Conduction

9. ICD Implant/Explant • ICD Indication

10. NOPR Registry and Variables Collected • Demographics Name SSN Patient’s 5 Digit Zip Code Date of birth Race Ethnicity Gender Date of Procedure PET Facility ID#

11. Specific Reason for PET Study • Restaging • Suspected Recurrence • Monitoring Treatment Response during chemotherapy during radiation therapy during combined modality therapy Diagnosis (Leukemia only) Diagnosis/Paraneoplastic (Leukemia only) Initial Staging (Leukemia only)

12. Cancer Type (ICD-9 Code) Kaposi sarcoma (176) Uterus, unspecified (179) Uterus, body (182) Prostate (185) Testis (186) Penis and male genitalia (187) Bladder (188) Kidney and other urinary tract (189) Eye (190) Primary Brain (191) Leukemia (204-208) Neuroendocrine tumor (209) Metastatic cancer unknown (203) Stomach (151) Small Intestine (152) Anus (154) Liver and intrahepatic bile ducts (155) Gall bladder & extrahepatic bile duct (156) Pancreas (157) Retroperitoneum and peritoneum (158) Lung, small cell (162) Pleura (163) Thymus, heart, mediastinum (164)

13. Cancer Type • Has this cancer diagnosis been pathologically proven? • Unknown primaries: Dominant site of pathologically proven or strongly suggested metastatic disease e.g., Lymph node, lung, liver, brain, bone, other

14. Stage Before PET Scan • No evidence of disease • Localized only • Regional by direct extension or lymph node • Distant metastasis with single suspect site • Distant metastasis with multiple susp. sites • Unknown or uncertain

15. Patient Performance Status • Asymptomatic, fully active • Symptomatic, fully ambulatory • Symptomatic in bed <50% of the day • Symptomatic in bed >50% of the day • Bedridden, completely disabled

16. Monitoring Treatment Responses • Is the current ongoing treatment intended to be • Curative or palliative?

17. Management Plans • If PET were not available, what management strategy would be used? Observation (with close follow up) Additional Imaging (CT, MRI, other NIT) Tissue Biopsy (surgical, percutaneous, endoscopic Treatment

18. Management Plan (cont.) • Treatment Goals Curative Palliative Types of Treatment Surgical Chemotherapy Radiation Supportive Car Will treatment be directly provided by you?

19. CED Data Sources • The website for the source to Medicare data is http://www.resdac.umn.edu/