There are 5 demographic data elements that include gender, date of birth, race, ethnicity status,

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1 Demographic and Data s There are 5 demographic data elements that include gender, date of birth, race, ethnicity status, and postal code of the patient. These elements are intended to be collected once for each patient. The race and ethnicity data elements are defined in a way that is consistent with standard formats suggested by the National Institutes of Health for use in federally sponsored research, which includes identification of Hispanic or Latino ethnicity. Postal code of the patient is included to permit for geographical analysis of results and comparison to other cardiovascular registry data analyses. There are 16 data elements and definitions that describe the status of care for the current data collection (whether in-patient or out-patient), and if in-patient, details about the date of admission, the source of admission, information about payment type, information related to the first medical contact, date and time of arrival and transfer at an outside facility, mode of transport to the local facility, and the location and time of the first evaluation in the local facility. These data elements define the critical aspects of timing and level of acuity for this presentation of the patient to the healthcare system. They provide the initial elements of information that articulate the risk of the patient and the impact of these factors on the entire episode of care and its outcomes. Data elements for admission source and type have been standardized on recent recommendations by CMS and TJC. Table 1: Demographic and Data s and Definitions Definition

2 Table 1: Demographic and Data s and Definitions Demographics Unique ID Gender Date of birth Race Ethnicity Postal code Care period Date Definition Participant ID is a unique number that permanently identifies each patient. Once assigned to a patient, this can never be changed or reassigned to a different patient. If a patient returns to the site, they MUST receive this same unique patient identifier. Indicate the patient s gender at birth as either male or female. Choose one of the following: Male Female Indicate the patient s date of birth. Indicate the patient's race as determined by the patient or family. Choose one of the following: Caucasian Black Asian Native American or Alaska Native Native Hawaiian or other Pacific Islander Other race not listed Indicate if the patient is of Hispanic or Latino ethnicity as determined by the patient/family. Hispanic ethnicity includes patient reports of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Choose one of the following: No Yes Indicate the postal code of the patient's residence. For the United States zip codes the hyphen is implied. If the patient is determined to not have a permanent residence, then the patient is considered homeless. For inpatient, note the date the patient was admitted to the hospital and the date the patient was discharged from the hospital. For outpatient, note the date (day, month, year) of the encounter (physician visit, nurse visit, consultation, procedures, and so on). Indicate the date the patient was admitted as an inpatient to your facility for the current episode of care.

3 Table 1: Demographic and Data s and Definitions Source Insurance Payor Definition Indicate the source of inpatient admission for the patient to your facility. Choose one of the following: Physician referral - The patient was admitted to this facility upon recommendation of his or her personal physician. Clinic referral - The patient was admitted to this facility upon recommendation of this facility's clinic physician. HMO referral - The patient was admitted to this facility upon recommendation of a health maintenance organization physician. from a hospital (Different Facility*) - The patient was admitted to this facility as a hospital transfer from a different acute care facility where he or she was an inpatient. from Skilled Nursing Facility - The patient was admitted to this facility as a transfer from a skilled nursing facility where he or she was an inpatient. from Another Health Care Facility - The patient was admitted to this facility as a transfer from a health care facility other than an acute care facility or a skilled nursing facility. This includes transfers from nursing homes, long term care facilities and skilled nursing facility patients that are at a non-skilled level of care. Emergency Department (ED) - The patient was admitted to this facility upon recommendation of this facility's ED physician. Court/Law Enforcement - The patient was admitted to this facility upon the direction of a court of law or upon the request of a law enforcement agency representative. Information Not Available - The means by which the patient was admitted to this hospital is not known. from a Critical Access Hospital - The patient was admitted to this facility as a transfer from a Critical Access Hospital where he or she was an inpatient. from Hospital Inpatient in the Same Facility Resulting in a Separate Claim to the Payer - The patient was admitted to this facility as a transfer from hospital inpatient within this facility resulting in a separate claim to the payer. Indicate the appropriate description of the patient's insurance carrier(s) for this admission. If the patient has more than one, choose all that apply: Medicare A federal health care plan that reimburses hospitals and physicians for medical care provided to qualifying people of age 65 years or older, people under age 65 years with certain disabilities, and people of all ages with end-stage renal disease. Medicaid Any state and federal health care program that reimburses hospitals and physicians for providing care to qualifying people who cannot finance their own medical expenses Commercial Any health insurance provided by a commercial plan, regardless of the type of restrictions or payment arrangements. This includes managed care plans such as HMOs, PPOs, POSs and IPAs. Military/VAMC Refers to any military or Veterans Administration Health Plans, and PHS. Non-U.S. Insurance - refers to individuals with no or limited health insurance; thus, the individual is the payer regardless of ability to pay. None/Self Pay - refers to situations when the individual is the sole payer regardless of his/her ability to pay. Check this choice only when self or None is listed as the first insurance in the medical record.

4 Table 1: Demographic and Data s and Definitions Government insurance type Presentation (to healthcare facility): First Evaluation Location Your ED red out of ED Type of admission location Definition Indicate the type of insurance if the patient's primary insurance payor is government. Choose all that apply: Medicare - Medicare is the Federal program which helps pay health care costs for people 65 and older and for certain people under 65 with long-term disabilities. Medicaid - Medicaid is a program administered at the state level, which provides medical assistance to the needy. Families with dependent children, the aged, blind, and disabled who are in financial need are eligible for Medicaid. It may be known by different names in different states. Military Health care - Military health care includes TRICARE/CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), as well as care provided by the Department of Veterans Affairs (VA). State-specific plan - Some states have their own health insurance programs for low-income uninsured individuals. These health plans may be known by different names in different states. Indian Health Service - Indian Health Service (IHS) is a health care program through which the Department of Health and Human Services provides medical assistance to eligible American Indians at IHS facilities. In addition, the IHS helps pay the cost of selected health care services provided at non-ihs facilities. Date and time the patient first presented to the hospital Indicate if the patient was first evaluated in the ED of your facility. This includes traditional ED locations, as well as ED-based chest pain units, clinics, and short-stay coronary-care units housed in the ED. If the patient was first evaluated in the ED of your facility, enter the date and time the patient was moved out of the ED, either to another location within your facility or to another acute care center. The categories of type of admission are as follows: Elective (i.e., scheduled more than 24 hours before hospital arrival) Urgent (i.e., through the emergency department, or directly from a physician s office or transferred from another facility) The categories of location of patient at the time of admission to the hospital or observation unit are as follows: Coronary or intensive care unit (CCU/ICU) Step-down unit/monitored bed/cardiac ward Unmonitored hospital floor Observation unit/emergency department chest pain unit

5 Table 1: Demographic and Data s and Definitions Non- Means of Transport Pre-arrival first medical contact - Means of Transport Definition Indicate the means by which the non-transfer patient was transported to your facility. Choose one of the following: Self/family Ground-transport ambulance (includes provider, private provider, or hospital based) Air Ambulance (helicopter or fixed wing) Ambulance Mobile intensive care unit (ICU) Unknown Indicate the date and time of pre-hospital first medical contact, when the patient was first evaluated by either emergency medical services (EMS) or another healthcare professional prior to arrival at your facility. This is not the date and time of arrival to your facility. Note: Enter the date and time of first medical contact only for patients who were transported by ambulance (ground or air) or mobile ICU. Indicate if the patient was transferred directly to your facility from another ED or hospital unit and indicate which Indicate the means by which the transfer patient was transported to your facility. Choose one of the following: Mobile ICU Air Ambulance (helicopter or fixed wing) transfer from another facility Ground-transport Ambulance transfer from another acute care facility Provider - Hospital based - Private Provider - Unknown Arrival at outside hospital - from outside hospital - Indicate the date and time the patient arrived at the outside hospital. If unknown, leave blank. Indicate the date and time the patient left the outside facility.

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