MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY

Transcription

1 MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY In order to improve the efficiency of PINNACLE Registry data analytics, a missing data analysis has been conducted on PINNACLE Registry data elements. Presence of data was captured across all disease states for demographic data, and within the most relevant disease state (Hypertension, Atrial Fibrillation, Heart Failure and Coronary Artery Disease) for that data element. The analysis was run on the most recent patient encounter ranging between November 1, 2012-November 1, PINNACLE employs a largely passive and retrospective data collection methodology, extracting data from practice electronic health record (EHR) systems. This approach offers many advantages, including scalability, historical data capture, and easier adoption by data submitting sites. However, we cannot force capture of all data elements at all patient office visits. If a data element is not present, or not present in a recoverable fashion in the source electronic health record (EHR), that element will not be included in the patient encounter record transmitted to PINNACLE. Several additional and related factors can introduction variation into the completeness of data elements within the PINNACLE Registry: Negative data capture (i.e. probability that a clinician will document no when a patient has not had a cardiac event, does not have a disease or symptom, etc.). o In many cases, the default value for a data element is NULL (i.e. missing), if it is not a documented yes. However, in some cases, a NULL value may indicate no. o Please refer to the coder s data dictionary in order to understand default values for each element The PINNACLE Registry collects data at the individual office visits level for patients with CAD, HT, AF, and/or HF. o Many data elements are not expected to be collected for every patient office visit. Lab values in particular may be collected less frequently. For example, a patient may have multiple office visits across a calendar year but only have an annual lipid panel. These elements would not be expected to be present at every encounter. o Elements related to disease states that a patient does not have are unlikely to present in that patient s encounter record. For example, a patient with a diagnosis of HT only is unlikely to have a documented NYHA functional class. Variation in EHR structure of registry participants o Not all EHRs will have fields for all PINNACLE data elements. o While many EHRs have flexibility to build in structured fields for new data elements, and PINNACLE Support staff encourages practices to build new fields, not all practices may choose to do so for every data element. Variation in EHR use and practice patterns by practice o Clinicians may vary in the way that they practice medicine, focusing on some symptoms and not others.

2 Table 1: Missing Data Analysis Among All Patients in the PINNACLE Registry Insurance Sex Tobacco Use Race Death Date Patient Deceased 1

3 Table 2: Missing Data Analysis Among Heart Failure (HF) Patients in the PINNACLE Registry 6405 Peripheral Edema Present Left Ventricular Ejection Fraction (LVEF) Date Dyspnea Present HF Education - Physical Activity Left Ventricular Ejection Fraction (LVEF) Percent HF Education - Medication Instruction HF Education - Symptom Management HF Education - Diet Sodium Restriction Jugular Venous Distention Present S3 Gallop Present S4 Gallop Present HF Education - Weight Monitoring Orhopnea Present Rales Present Body Mass Index Screening New York Heart Association Functional Classification for Heart 28 Failure 6515 HF Education - Smoking Cessation Hepatomegaly Present HF Education - Prognosis/End-of-Life Issues HF Education - Minimizing or Avoiding Use of NSAIDs HF Education - Referral for visiting nurse or specific education or 5 management programs 6510 HF Education - All of the following Body Mass Index Management Plan 0

4 Table 3: Missing Data Analysis Among Atrial Fibrillation (AF) Patients in the PINNACLE Registry 6600 Afib/Flutter Duration Thromboembolic Risk Factors Assessed Afib/Flutter Type Etiology - Transient /Reversible Cause 1

5 Table 4: Missing Data Analysis Among Hypertension (HTN) Patients in the PINNACLE Registry 6010 Systolic Blood Pressure Diastolic Blood Pressure Heart Rate 90

6 Table 5: Missing Data Analysis Among Coronary Artery Disease (CAD) Patients in the PINNACLE Registry 4010 Dyslipidemia Left Ventricular Ejection Fraction (LVEF) Percent Left Ventricular Qualitative Assessment Total Cholesterol High Density Lipoprotein (HDL) Triglycerides Low Density Lipoprotein (LDL) Glucose Stable Angina Canadian Cardiovascular Society (CCS) Class PCI Drug Eluting Stent Implant PCI - Other (non-stent) Intervention HbA1c Percentage PCI Bare Metal Stent Implant Cardiac Rehabilitation Referral or Plan for Qualifying Event/Diagnosis in past 12 months 6