2008 COAP Audit Results & Progress. Kristin Sitcov COAP Program Director

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1 2008 COAP Audit Results & Progress Kristin Sitcov COAP Program Director

2 Audit Rationale

3 Rationale: Popular request Always had inter-rater reliability will continue Way to assess agreement with standards Practical way to demonstrate data quality Method of determining any inconsistency with specific data definitions Way to review and update Opportunity to have face to face contact, answer questions, review outcomes Education Year one, strictly educational

inconsistency with specific data definitions Way to review and update Opportunity to have

4 Audit Methodology

6 Methodology: In 2008 we will visit every COAP hospital Since January, we have completed 16 of the 30 sites June November we will visit the remaining sites Special thanks to Northwest Hospital and Overlake Medical Center for being pilot sites

we will visit the remaining sites Special thanks to

7 The COAP Audit Process

8 COAP Audit Process: DCRI randomly selects 15 PCI cases and 5 surgical cases Hospitals sent list of cases and data elements DCRI sends COAP the data for each of the elements that was reported on those cases Hospital pulls charts & flags sections

elements DCRI sends COAP the data for each of the elements

9 COAP Audit Process: 59 PCI data elements 44 Cardiac surgery elements Critical elements chosen: - Those that impact risk stratification - Those related to clinical outcome indicators

10 COAP Audit Process: Audit team reviews each chart for evidence of documentation for each data element Approximately 2 hours for PCI only; 3 hours for PCI + cardiac surgery cases Report generated based on percentage of total data elements matched for accuracy Available to discuss in detail any discrepancies or questions

cardiac surgery cases Report generated based on percentage of total data

11 Audit Findings to Date:

12 Audit Findings: Paper Only EMR Paper + Electronic

13 PCI Audit Results

14 Cardiac Surgery Audit Results

15 Definition Questions: We understand and appreciate the confusion with some of data definitions working to continually address these questions Much will be solved through STS/ACC harmonization efforts

16 Inclusion Criteria: Primary PCI All ACS-STEMI All ACS-NonSTEMI All Unknown MI Type All patients with MI less than 24 hours before the procedure and the priority being anything other than elective A small percentage of patients with MI >6 hours from onset, coded as procedure done for acute MI and coded as elective In 2007: 95% of cases classified as emergent were primary PCI 46% of cases classified as urgent were primary PCI 5% of cases classified as elective were primary PCI

>6 hours from onset, coded as procedure done for acute MI and coded as elective In 2007: 95% of cases classified as

17 Inclusion Criteria: Non-Primary PCI All procedures done on patients who do not have AMI, regardless of priority of procedure (emergent vs. urgent) All elective procedures with exception of those done for acute MI (as noted previously) In 2007: 5% of cases classified as emergent were non-primary PCI 54% of cases classified as urgent were non-primary PCI 95% of cases classified as elective were non-primary PCI

urgent) All elective procedures with exception of those done for acute MI (as noted previously) In

18 Moving Forward Really helpful to have flagged sections Great learning process to actually flag all the important items Complete the remainder of sites in 2008 Continue audit in 2009 will add to set of compliance measures

important items Complete the remainder of sites in

19 Other changes for 2008 and beyond

20 Inter-Rater Reliability IRR will continue as a training tool Timing of IRR process will move to the fall

21 STS Harmonization Data Capture Period: Procedure Date Range Surgical Data: 30 Day Follow-up Data Submission Period Data Correction & Resubmission Report Distribution Q1 Jan 1 Mar 31 Apr 30 May 1-31 June 10 June 30 Q2 Apr 1 June 30 July 31 Aug 1-31 Sept 10 Sept 30 Q3 July 1- Sept 30 Oct 31 Nov 1-30 Dec 10 Jan 7 Q4 Oct 1- Dec 31 Jan 31 Feb 1-28 Mar 10 Mar 31

22 ACC Harmonization Discussions 15 of 30 COAP hospitals currently report data to ACC All indications that synchronization will happen Awaiting release of Version 4.0

23 Fee Structure Changes Flat fee billing initiated for 2008 Invoice recipients received a letter outlining new structure Fees consistent with 2006 or slightly reduced

24 Website Changes & Enhancements Welcome to the Forum: A secure, interactive site for COAP members to view data and reports, discuss cases and data submission issues, and learn best practice strategies from colleagues. A meeting place for a thriving community of health professionals committed to improving the quality of cardiac care. Sign up sheet in registration packets, turn in anytime this afternoon, or Kristin to designate your hospital s users

Analysis One Code Desc. Transaction Amount. Fiscal Period

Analysis One Code Desc. Transaction Amount. Fiscal Period Analysis One Code Desc Transaction Amount Fiscal Period 57.63 Oct-12 12.13 Oct-12-38.90 Oct-12-773.00 Oct-12-800.00 Oct-12-187.00 Oct-12-82.00 Oct-12-82.00 Oct-12-110.00 Oct-12-1115.25 Oct-12-71.00 Oct-12-41.00