Clinical Registriesin Cardiac Surgery
Peter S. Greene, MDCMIO, Johns Hopkins Medicine
Diane AlejoInformation Systems Manager
Division of Cardiac Surgery
September 15, 2010ICTR Clinical Registry Workshop
Cardiac Surgery Database spans 1944 - 2010• Clinical and administrative data tracking• Supports IRB approved clinical research activities• Allows longitudinal outcome follow-up
STS Adult Cardiac Surgery Data / STS Congenital Data
Heart and Heart- Lung Transplant Database
UNOS Registry
ISHLT / INTERMACS VAD Registry
Collaborative Transplant Research Database
Cardiac Surgery Data Management
History of Cardiac Surgery Database
933 1944-1950 Blalock-Taussig Registry
15,010 1950-1982 Cardiac Registry - Medical Archive’s Operative Logs
7,738 1983-1994 Cardiac Surgery Database & Cardiac Transplant Database
18,934 1996-2010 Expanded Data Collection - Point of Care / Work Flow Integration
42, 615 Total Operations recorded in the Databases
STS Adult Cardiac Surgery Database Participation
> 13,000 Johns Hopkins Adult Cardiac Operations submitted to STS from 1997- 2010
Clinical Documentation
STS
LeapFrog
NQFPQRI
Performance Improvement
Payers
Research Patient Care
Billing AdminReports
DATA
UNOSResident Education
Maintenance of
Certification
DRG Codes
STS Participation
LeapFrog / PQRINational Quality Forum
Performance ImprovementScore Cards
Maintenance of CertificationSurgeon / Resident Portfolios
APRDRG codes
Payers , RFI / RFP’s
ICD 9 codes
CPT codes
Administrative ReportingBilling / Resource Utilization
Cardiac Database
Consumers & Marketing
Sources of Data and Reporting For Outcome Measurement & Research in Cardiac Surgery
ClinicalData
Clinical Registries
Research Data
REPORTS
1. Must have strong clinical leadership and pervasive buy-in
2. Must integrate with clinical workflow
3. Must provide net benefit to clinicians
4. Must stay within scope of readily known data
5. Must have a stable and capable clinical team
6. Must have a stable and capable data team
7. Must audit for completeness
8. Must give regular feedback
9. Must pre-stage submissions
Some Lessons Learned
Standardized information on cardiac & thoracic surgical procedures
Data analyzed by separate, independent, objective data analysis center (DCRI)
Opportunities to improve patient care
# Participants # Records Harvest
Adult Cardiac 992 2.7+ million 4 times / year
General Thoracic 81 185,508 operations 2 times / year
Congenital 142 96,628 operations 2 times / year
STS National Database
STS Pilot Pay For Performance (P4P) Program
Incentive payments for achievement of thresholds in performance measures
A model of quality improvement with 3 types of measures:
Structureal: IT, database participation, volume
Process: IMA use, discharge beta blockers
Outcomes: Mortality, Morbidity: CVA, renal failure
Blended STS NCD and financial (UB-92) database
NQF performance measures
2007 PQRI Initiative – CMS
New 2007 STS Composite Scoring System
STS National Database
DCRI – Data Warehouse and Analysis Center
Data transmitted electronically
National, Regional and “Like Institution” benchmarking
Reports include site specific, risk adjusted, regional and national aggregate date including morbidity, mortality and LOS for CABG, Valves and CABG/Valve surgery
Statistical Analysis – Risk Modeling- Logistic Regression, Hierarchical regression modeling
STS National Database
STS Auditing
Risk factor model variables
NQF measures
Op log procedures
Operative deaths and morbidity
STS National Database
STS Adult Database 992
STS Congenital Database 81
STS Thoracic Database 142
Total 1215
STS National DatabaseParticipation
STS Composite Quality ScoreDistribution of Participant Site Ratings
12
77
11
0
25
50
75
100
March 2008
Perc
ent
STS Composite Quality Ratings
* Participant is significantly lower than the STS mean * * Participant is not significantly different than the STS mean * * * Participant is significantly higher than the STS mean
Jan – Dec 2009
JHH STS Rating
Overall 95.3 % 95.3 %
Avoidance of Mortality
97.3 % 97.9 %
Avoidance of Morbidity
82.6 % 84.5 %
Use of IMA 98.5 % 94.5 %Medications 80.2 % 76.0 %
Research InformaticsDepartment of Surgery
PREMISES OF THIS PROPOSALFOR A SURGERY DATA CENTER
• Almost every faculty member and research trainee has a need for accessing clinical data for research purposes
• There is insufficient revenue to support a centralized research database– There is a modest amount of research database activity in the
department• There is an extensive amount of clinical information
within JHMI in an electronic format, but these exist in multiple sources
• There is an extensive amount of surgical patient data being collected and analyzed for non-research activities (e.g.: safety, accreditation, payers, training)
IDXSALAR
Lung Cancer Database (M. Brock)STS Thoracic Database
Transplant Information SystemsTeleresults
UNOS / CTRD
Maryland Trauma Registry
AnesthesiaADR
Specialty SurgicalResearch Databases
ORMIS
CasemixCVIEW Cardiac Surgery Database
STS Adult Cardiac / Congenital
Surgery
Core
ISHLT VAD Registry
Internal Data Sources and Internal Database Initiatives
ClinicalData
NSQIP
Research Data
EPR
POE
Tumor Registry
Departmental Prototype
Clinical Trial Databases
Idea – Explore Influence of Randomness
Idea – Quality Collaborative
Idea – Patient Registries
From Dr. Adrian PuttgenDept. Neurology, Critical Care
http://www.youtube.com/watch?v=WQ2PFoHptK8
1. Unique patient population
2. Unique patient tracking capability
3. Unique patient detail or comprehensiveness
4. Unique patient data integration
5. Regional quality programs
6. National quality programs
Clinical Registry Opportunities
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