Texas Heart Attack and Stroke Data Collection Initiative: Data Update Nimisha Bhakta, MPH Texas Heart Attack and Stroke Summit July 24, 2015
Presenter Disclosure Information FINANCIAL DISCLOSURE: I have no commercial interest to disclose. UNLABELED/UNAPPROVED USES DISCLOSURE: There is no intended unlabeled/unapproved use in this presentation. 2
Presentation Overview Data collection project Data security and governance measures Data management and analysis Heart attack related hospital performance measures Stroke related hospital performance measures Benefits to participating hospitals 3
Project Background During the 83rd Regular Texas Legislative Session, funds were appropriated to advance heart attack and stroke reduction efforts throughout Texas. The Texas Council on Cardiovascular Disease and Stroke launched a heart attack and stroke data collection initiative. Voluntary participation from hospitals enrolled in the Get With The Guidelines Program. 4
Project Purpose The objective of the data collection initiative is to gain an understanding of the heart attack and stroke systems of care in Texas and evaluate pre-hospital and hospital care of heart attack and stroke patients. Identify areas of improvement in heart attack and stroke care. Inform stakeholders of the current state of systems of care. Recognize achievement among hospitals across the state. 5
Project Implementation Heart attack data participation packets were emailed to hospitals on July 23, 2014 55 hospitals have submitted forms for participation Stroke data participation packets were emailed August 22, 2014 47 hospitals have submitted forms for participation Hospitals can start participating on a rolling basis 6
Participation by RAC as of July 2015 12 RACs include hospitals participating in STEMI data (55 hospitals). 15 RACs include hospitals participating in stroke data (47 hospitals). 7
DSHS Data Security and Governance Data use agreements Vendors Hospitals Data access/storage DSHS secure network drive password protected, non-portable computers Access to 2 OSER epidemiologists and Manager Data governance DSHS has a data governance plan Data storage, access, and use are guided by the governance plan, DSHS IT Operations department, IT Security Analysts, and IT Security Officer 8
Data Management Hospitals Heart attack Data Stroke Data NCDR-ACTION Registry (ACCF) GWTG-Stroke Registry (Quintiles) DCRI ( STEMI data) Mission: Lifeline reports Hospitals DSHS 9
Data Management (contd.) Office of Surveillance, Evaluation and Research (OSER) at DSHS Council consultants Data analysis DSHS aggregate report Review by vendors Report dissemination Councils (TCCVDS and GETAC) RACs Hospitals 10
Data Reports Report elements developed with input from Rider 97 data consultants State-wide aggregate measures Focus on time to treatment indicators Six total reports have been published (three for each disease state), latest report includes annual trends http://www.dshs.state.tx.us/heart/council-projects.aspx - The latest reports are included in your packets 11
Heart Attack Hospital Performance Measures
Heart Attack Indicators Pre-hospital ECG within 10 minutes of first medical contact Time from first hospital arrival to first ECG First ECG within 10 minutes of first hospital arrival Dwell time in the emergency department (ED)* Dwell time in the emergency department of referring hospital Dwell time in the emergency department of receiving hospital First door to needle time for transfer patients 13
Heart Attack Indicators (cont d) Door to needle time within 30 minutes for transfer patients Door to balloon time for directly admitted patients Median time from hospital arrival to primary PCI (in minutes) Primary PCI within 90 minutes of hospital arrival First door to balloon time for transfer patients Median time from first hospital arrival to primary PCI (in minutes) Primary PCI within 120 minutes of arrival to first hospital 14
Key Findings Data from 49 participating hospitals were analyzed for the period of October 2008-December 2014. 33,138 individual episodes of care for heart attack occurred among 31,891 patients at participating hospitals - 32.9% STEMI - 59.9% of patients transported to the hospital by private vehicle - 77.4% received their first ECG upon arriving at the first hospital 15
Pre-hospital ECG within 10 minutes Percent (%) 100 90 87.9 80 70 72.9 70.2 70.0 73.8 71.7 60 50 40 30 20 10 0 2009 2010 2011 2012 2013 2014 Year 16
ECG within 10 minutes of hospital arrival Percent (%) 100 Personal Vehicle 90 Ambulance 80 75.7 66.2 65.8 67.7 70 62.3 62.8 69.1 60 65.9 61.7 58.9 58.9 50 55.3 40 30 20 10 0 2009 2010 2011 2012 2013 2014 Year 17
Dwell time in the ED of receiving hospital among transfer patients Minutes 80 69.5 70 60 60 50 43 40 35.5 43 29 38 30 62.5 36 Personal Vehicle Ambulance 20 10 22.5 24 26 0 2009 2010 2011 2012 2013 2014 Year 18
Door to balloon time for directly admitted patients Minutes 80 70 66 68 68 60 66 Personal Vehicle Ambulance 50 40 54 52 53 52 30 20 10 0 2009 2010 2011 2012 2013 2014 Year 19
Door to balloon time within 90 minutes among directly admitted patients Percent (%) 120 100 97.8 96.9 98.5 97.2 Personal Vehicle Ambulance 80 89.6 89.8 89.3 92.5 60 40 20 0 2009 2010 2011 2012 2013 2014 Year 20
Door to balloon time within 120 minutes among transfer patients Percent (%) 100 89.0 90 81.5 80.2 77.4 80 Personal Vehicle Ambulance 70 60 67.2 68.2 72.1 73.3 50 40 30 20 10 0 2009 2010 2011 2012 2013 2014 Year 21
Stroke Hospital Performance Measures
Stroke Indicators Arrival mode National Institutes of Health Stroke Scale (NIHSS) reported Time to initial brain imaging Time to IV thrombolytic therapy IV tpa arrive by 2 hours, treat by 3 hours IV tpa arrive by 3.5 hours, treat by 4.5 hours Drip and ship therapy* Endovascular therapy * Thrombolytic complications* Rehabilitation considered Discharge disposition 23
Key Findings Data from 40 participating hospitals were analyzed for the period of January 2008-December 2014. 54,966 cases of stroke reported - 65.4% ischemic stroke - Median age of patient was 69 years - 51.7% women - 34.9% of patients transported to the hospital by private vehicle 24
Percent (%) Arrival Mode for Stroke Patients 60 50 40 30 20 10 0 2008 2009 2010 2011 2012 2013 2014 EMS from home scene Private transport/taxi/other from homes/scene Transfer from other hospital ND/Unknown Null/Missing 25
Percent (%) NIH Stroke Scale Score Reported 100 80 67.6 81.3 81.9 85.3 91.3 60 53.2 44.2 40 20 0 2008 2009 2010 2011 2012 2013 2014 Year 26
CT Scan Within 25 Minutes of Arrival Percent (%) 100 80 60 40 39.3 46.9 58.9 59.5 57.9 60.2 66.7 20 0 2008 2009 2010 2011 2012 2013 2014 Year 27
Percent (%) IV tpa Within 60 Minutes 100 80 60 56.5 60.2 40 38.4 38.0 44.3 20 15.2 16.1 0 2008 2009 2010 2011 2012 2013 2014 Year 28
Percent (%) IV tpa: Arrive by 2h, treat by 3h 100 93.9 94.5 93.6 95.3 96.2 90 90 90.29 80 2008 2009 2010 2011 2012 2013 2014 Year 29
Stroke Hospital Discharge Disposition 60 50 Percent (%) 40 30 20 2011 2012 2013 2014 10 0 Home Hospice-Home Hospice- Health Care Facility Acute Care Facility Other Health Care Facility Expired Left Against Medical Advice/AMA 30
Percent (%) Stroke Hospital Discharge Disposition Among other health care facility 70 60 50 40 30 20 2011 2012 2013 2014 10 0 Skilled Nursing Facility (SNF) Inpatient Rehabilitation Facility (IRF) Long Term Care Hospital (LTCH) Intermediate Care facility (ICF) Other 31
How It Can Benefit Hospitals Assist in the improvement of care for these patients across the state. Identify areas of improvement within your hospital for stroke and heart attack care. Receive a copy of DSHS aggregate reports. Receive a copy of the Mission: Lifeline Statewide Report, allowing individual hospitals to compare their STEMI care to the rest of the participants in the state, utilizing a unique identifier. For hospitals who are not enrolled in a Mission: Lifeline System/Regional Report, this would offer an opportunity to become a part of a regional report. 32
Acknowledgement All of our partners, including: Participating hospitals Texas Council on Cardiovascular Disease and Stroke and their data consultants Regional Advisory Councils DSHS project team 33
Thank You! Nimisha Bhakta, MPH Nimisha.bhakta@dshs.state.tx.us 512-776-3554 http://www.dshs.state.tx.us/chronic/