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Key Quality Metrics

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Key Quality Metrics

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    1. Key Quality Metrics

    2. Identification of Key Metrics

    3. Composite Measures Overall Guidelines Composite Acute Guidelines Medications Discharge Guidelines Medications Overall CMS Guidelines Composite

    4. Guideline Recommendations

    5. Guideline Recommendations

    6. Analysis Eligible patients Care opportunities Adherence score Hospital rank Score Distribution

    7. Recommendation Elements

    8. Identification of Needs Identify the element for review Identify the prevalence Identify the importance Share the information

    9. Application of information Slide Sets Multi-disciplinary team presentations Apply to local process Develop intervention Control Reevaluate Apply to process

    10. D2B Metrics Brittany Cunningham, MSN, RN Quality Consultant Vanderbilt Heart Institute Vanderbilt Medical Center Nashville, TN

    11. D2B monitoring system

    12. ACTION Quarterly Reports Door to ECG Median Time of 1st ECG ECG within 10 min of Presentation ECG Obtained Pre-Hospital All comparable to national hospitals

    13. Door to Balloon Door to Balloon, Non-Transfer In, % # of Pts Mean Median <=90 minutes, %

    14. ED Meds ASA Plavix Loading dose =300mg Loading dose>=600mg Anticoagulant agents Beta Blocker

    15. D2B Qtr 2 2007

    16. D2B Qtr 4 2007

    17. Lead the Team Dawn Leiva, RN, CCM, CPUR Quality Improvement Coordinator Patient Safety and Accreditation Dept. Lakeland Regional Medical Center Lakeland, FL

    18. Overview Acute Guideline Composite Antiplatelet, BB, reperfusion, door to needle, door to balloon Total CMS Guidelines Composites Acute/discharge ASA, acute/discharge BB, door to needle, door to balloon, Ace-I/ARB, Lipid Lowering agents, smoking cessation Overall Reperfusion Thrombolytic or PCI Door to Balloon <=90 minutes (all pts receiving Primary PCI)

    19. Deploy The findings In our hospital, the findings from these reports each qtr are reviewed and discussed in our chest pain committee and also in the Cardiology Service Meeting with our physicians. We make changes in our hospital practices based on our ratings, especially based on findings from the CMS composite guidelines.

    20. What We Look For Overall Guidelines Composite- overall adherence on acute and discharge guidelines. NSTEMI/ STEMI measures 10 acute and discharge therapies, plus 3 discharge secondary prevention measures: smoking cessation, dietary modification, and cardiac rehab.

    21. Data Elements-Acute NSTEMI                                           STEMI           Antiplatelet                                    Antiplatelet Clopidogrel                                    Beta Blocker Beta Blocker                              Overall Reperfusion Heparin                           Door to Needle<30 min. GP IIb-IIIa inhibitor              Door to Balloon<90 min.

    22. Data Elements-Discharge NSTEMI                                           STEMI             Antiplatelet                                 Antiplatelet Clopidogrel                                  Beta Blocker Beta Blocker                                ACE/ ARB therapy ACE/ARB therapy in select pts.    Lipid-Lowering Statin Lipid-Lowering agent in select pts.  

    23. How They Apply Acute Medications Guidelines- Medications given within the first 24 hours Discharge Medications Guidelines- Medications prescribed at discharge

    24. What is Important Total CMS Guidelines Composite: ( nationally reported information) Adherence on 6 therapies specified by CMS (Centers for Medicare Services): NSTEMI/STEMI: acute and discharge aspirin, acute and discharge beta blocker, discharge ACE-1 or ARB ( select pts) and smoking cessation counseling; STEMI only: door to needle <30 minutes and door to balloon <90 minutes.

    25. ACTION to Action Define Your State Inform Your group Improve the Status Quo Determine your needs based on outcomes Identify the sources Develop your team Provide those that manage the process with feedback. Show how changes affect the outcome Change is just change Identify the needs and demonstrate the opportunities Plan, Do, Study, Act Determine your needs based on outcomes Identify the sources Develop your team Provide those that manage the process with feedback. Show how changes affect the outcome Change is just change Identify the needs and demonstrate the opportunities Plan, Do, Study, Act

    26. Contact Us ncdr@acc.org 1800.257.4737

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