Advances in Quality & Outcomes, 2012 Procedure Identification

Transcription

1 Advances in Quality & Outcomes, 2012 Procedure Identification Paul Meehan Rachel S. Dokholyan Duke Clinical Research Institute Cynthia Piotter Northwestern Memorial Hospital

2 Nothing to disclose

3 Procedure Identification (aka ProcID) WHAT IS IT? The process of classifying a surgical case into the appropriate procedure category Each case is assigned a ProcID WHY DO WE DO IT? All CABG procedures are not created equal and cannot be analyzed together Concomitant procedures change patient risk HOW DO WE DO IT? We review the values of selected data fields to determine if they meet certain conditions

4 Procedure Identification (aka ProcID) WHO DOES IT? DCRI During harvest data processing ProcID has already been determined by the time you receive your Data Quality Report! STS certified software If your software provides risk-adjustment, the software also determines ProcID NOTE!: DCRI does NOT use (or rely upon) the ProcID produced by your vendor software

5 Why change the ProcID determination approach? New method takes more into consideration: Transcatheter/Percutaneous valve procedures Canceled cases Unplanned procedures V2.73 specifications contain this information Taking advantage of what we have

6 Chart method will no longer work Too many data field conditions to be able to put them into a single row in a table

7 New method for determining ProcID: FLOW CHART

8 New method for determining ProcID: FLOW CHART (Cont.) Takes you through the various conditions Some data fields checked more than once Looks intimidating, but is very easy to use Don t try to understand the flow chart just follow it

9 How to use the ProcID flow chart Method looks at one data record at a time using the values in that record Each shape has a specific meaning:

10 How to use the ProcID flow chart (cont.) Oval = Start Start with each at the top of page 1:

11 How to use the ProcID flow chart (cont.) Diamond = condition Evaluate the contents of the diamond Most contain just one field name ( short name ), but some contain multiple fields Each diamond has two or three arrows branching out

12 How to use the ProcID flow chart (cont.) Arrows Each labeled with results of the evaluation May include more than one choice Missing is usually one of the choices Follow the arrow labeled with the result of the evaluation

13 How to use the ProcID flow chart (cont.) Arrows All arrows are One way

14 How to use the ProcID flow chart (cont.) Square = Information Provides information about what has been ruled out Note arrow leading in and another leading out Procedure Identification Note, no arrow leading out

15 How to use the ProcID flow chart (cont.) Page connector Leaving the page Top of the next page

16 How to use the ProcID flow chart (cont.) A few tricky spots All of the following are No or missing

17 How to use the ProcID flow chart (cont.) A few tricky spots Congenital procedures Two varieties of these

18 How to use the ProcID flow chart (cont.) A few tricky spots Evaluation of Any other value

19 How to use the ProcID flow chart (cont.) Goal is to reach one of the squares that states the procedure type Isolated procedure ProcID not defined ( Other procedure)

20 How to use the ProcID flow chart (cont.) Start back at the beginning for the next case

21 Example 1: Patient was going to have a CABG procedure and an aortic valve replacement, but case was canceled after patient entered the operating room.

22 Example 2: Patient had a planned CABG procedure and no other procedures.

23 Example 3: Patient went to OR to have a planned CABG. During the procedure, a surgical complication resulted in the aortic valve being damaged and needed to be replaced. No other procedures were done.

24 Web utility to take you through the flow chart Will be available on the STS web site shortly after AQO Each screen displays: The field name(s) shown in the diamonds of the flow chart A link for each possible choice Click on the link that applies to this case Utility takes you to the next appropriate screen Continue until the screen provides you with the ProcID

25 How large is the impact of the new ProcID? OLD PROCID NEW PROCID CABG Other Procedure % CABG 103, % AVR % MVR % AVR+CABG % MVR+CABG % AVR+MVR % MVRepair % MVRepair+CABG % TOTAL 103, % CABGs unchanged 0.1% CABGs reclassified

26 Will this be incorporated into my software? STS Software vendors are aware changes to the procedure are coming It is not mandatory that the vendors update your software to the new algorithm Due to contract agreements Software changes first have to go through a verification process Changes will be rolled out to sites as soon as possible

27 Implementation of new ProcID New ProcID algorithm and web utility will be available on STS website shortly after AQO DCRI will begin using the new ProcID with 2012 Harvest 4 that begins 11/5/2012 Vendors will not have enough time to update your software before the harvest Risk scores will likely not match in this harvest Will match again in future harvests after software is updated

28 What will be done with my historic data? The data warehouse will recalculate Procedure ID for all 2.73 cases we currently have for your site and will recalculate risk scores We recommend resubmitting all v2.73 data after your software is updated Will help ensure local data was updated correctly and matches data in the data warehouse Not required, just a good idea