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, 2013. 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.
Table 1: Missing Data Analysis Among All Patients in the PINNACLE Registry 3020- Insurance 100 3028 2060 Sex 99 6030 Tobacco Use 88 2070- Race 72 2076 2067 Death Date 9 2065 Patient Deceased 1
Table 2: Missing Data Analysis Among Heart Failure (HF) Patients in the PINNACLE Registry 6405 Peripheral Edema Present 80 7000 Left Ventricular Ejection Fraction (LVEF) Date 74 6300 Dyspnea Present 72 6514 HF Education - Physical Activity 70 7005 Left Ventricular Ejection Fraction (LVEF) Percent 68 6516 HF Education - Medication Instruction 65 6513 HF Education - Symptom Management 61 6512 HF Education - Diet Sodium Restriction 60 6435 Jugular Venous Distention Present 57 6410 S3 Gallop Present 54 6430 S4 Gallop Present 54 6511 HF Education - Weight Monitoring 54 6305 Orhopnea Present 44 6400 Rales Present 42 6450 Body Mass Index Screening 34 6200 New York Heart Association Functional Classification for Heart 28 Failure 6515 HF Education - Smoking Cessation 16 6425 Hepatomegaly Present 13 6517 HF Education - Prognosis/End-of-Life Issues 8 6518 HF Education - Minimizing or Avoiding Use of NSAIDs 5 6519 HF Education - Referral for visiting nurse or specific education or 5 management programs 6510 HF Education - All of the following 4 6455 Body Mass Index Management Plan 0
Table 3: Missing Data Analysis Among Atrial Fibrillation (AF) Patients in the PINNACLE Registry 6600 Afib/Flutter Duration 36 6615 Thromboembolic Risk Factors Assessed 19 6605 Afib/Flutter Type 3 6610 Etiology - Transient /Reversible Cause 1
Table 4: Missing Data Analysis Among Hypertension (HTN) Patients in the PINNACLE Registry 6010 Systolic Blood Pressure 95 6011 Diastolic Blood Pressure 95 6015 Heart Rate 90
Table 5: Missing Data Analysis Among Coronary Artery Disease (CAD) Patients in the PINNACLE Registry 4010 Dyslipidemia 83 7005 Left Ventricular Ejection Fraction (LVEF) Percent 63 7010 Left Ventricular Qualitative Assessment 63 7025 Total Cholesterol 47 7030 High Density Lipoprotein (HDL) 47 7040 Triglycerides 47 7035 Low Density Lipoprotein (LDL) 46 7060 Glucose 35 4055 Stable Angina 20 6100 Canadian Cardiovascular Society (CCS) Class 16 5026 PCI Drug Eluting Stent Implant 12 5036 PCI - Other (non-stent) Intervention 12 7075 HbA1c Percentage 11 5016 PCI Bare Metal Stent Implant 7 6505 Cardiac Rehabilitation Referral or Plan for Qualifying Event/Diagnosis in past 12 months 6