RESEARCH POSTER PRESENTATION DESIGN © 2015 www.PosterPresentations.com Benefits for Cone Health Joining the PVI Registry When there was a sharp increase in bleeds and complications Q3 at Cone Health , it was quickly noted and all cases were reviewed by the team for trends. During the review no trends were found. Wanda Shelton RN,BC BSN D-ilemmas, ch-A-llenges, T-rials, A-ccomplishments (DATA) Cone Health Quality Dept. Introduction The Peripheral Vascular Interventions Registry Health care has evolved into something that most of us would not have thought possible before. With the rising cost of health care in America, the current economy, and our movement towards globalization in the health care industry, following best evidence based practices is very important. Cone Health’s voluntary participation will continue to ensure that we are top performers in providing care to the peripheral vascular disease patient population. Triggers By Numbers ▪ Affects 10-12 million Americans ▪ 200 million have PAD globally ▪ 75% unaware of PAD risk ▪ 1 out of 3 diabetics have PAD ▪ African-Americans 2X more likely to develop PAD ▪ Smokers have a 4x greater risk of developing PAD ▪ Those who have a hx of MI or stroke have a 3x greater chance of developing PAD ▪ 70% of PCPs unaware of the presence of PAD in their patients ▪ 50% of patients who have PAD and require a LE amputation – die within 5 years of losing the limb ▪ By 2024 vascular disease will claim the lives of 2 million Americans each year Dr. Muhammed Arida (PVI Registry Champion) Cheryl Booth Karen Bartles Angela Moore Rebekah Myers Dr. Christopher Dickson Mary Godley Vangela Swafford Donna McCoy Dr. Vance Brabham Dr. Gregory Schnier Laurie Freeman Dr. Jonathan Berry Dr. Jason Dew Sarah Lackey RN Dr. Jagadeesh Ganji ARMC Cath Lab Team Edward Donnald John Dixon ARMC IR Team Teresa Schrader Rodney Cox Edith Apple RN Abbie Samuel Cone Cath Lab Team Jackie Mullins Julie McBride Acknowledgements • Deepak L. Bhatt, MD, MPH, FACC, FAHA et al; Journal of the American College of Cardiology, ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise, A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons, vol. 66 no. 20 2230- 2245, http://dx.doi.org/10.1016/j.jacc.2015.07.010 • National Cardiovascular Data Registry Website, https://www.ncdr.com/webncdr/home/registry-selection • American College of Cardiology website, Tools and Practice Support, www.acc.org . • Rooke TW, et al. 2011 ACCF/AHA Focused update of the guidelines for management of patient with peripheral artery disease. J Am Coll Cardiol, 58919): 2020-2045 • Olin JW, Allie DE, Belkin M, et al. 2010 Performance Measures for Adults with Peripheral Artery Diseases: A Report of the ACC Foundation/AHA Task Force on Performance Measures. J Am Coll Cardiol. 2010;56(25):2147-2181. doi:10.1016/j.jacc.2010.08.6 06. • Facts About Peripheral Arterial Disease, Aug 2006, NIH Publication No 06-5837, www.PADcoalition.org • Peripheral Arterial Disease (PAD) Fact Sheet, June 16, 2016. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_pad.htm . • Criqqui, Michael H Aboyans, Victor. Epidemiology of Peripheral Artery Disease, Circulation Research April 23, 2015; http://circres.ahajournals.org/content/116/9/1509 • Tsai, Thomas T, MD, MSc, The NCDRs PVI Registry Improving Quality for PVD Patients, CardioSource WorldNews Interventions. Sept, 2014; http://www.acc.org/latest-in- cardiology/articles/2014/05/22/14/43/peripheral-matters • Improving Vascular Disease Prevention, Detection and Treatment; A Conference Report from the American Heart Association Vascular Disease Thought Leaders Summit, Aug. 20, 2015 Conclusion and Nursing Implications The PVI Registry is just a small piece of the registry world. As nurses, we have an obligation to educate our patients on the risks of developing PAD. Also as nurses, we have an obligation to understand the implication of data collection and how it is used. As we go forward, healthcare is moving away from pay for service models and toward pay for performance models. Data, such as that being collected through registries and core measures, is one way of proving that patients are getting the best care available. It also provides a method to improve patient care and patient outcomes. Good clean data is dependent upon complete and accurate documentation. With public reporting, it will become imperative that our data is as good as, or better than, that of our competition. We provide great care to our patients, and our documentation needs to reflect that; then our data will prove it! Comparing Recommendation to Results • Resting ABIs should be reported as abnormal (ABI ≤ 0.90), borderline (ABI 0.91-0.99), normal (1.0-1.4) or noncompressible (ABI > 1.4) • Resting ABIs are recommended in patients with a history or physical examination suggestive of PAD, with or without segmental pressures or waveforms. • In patients at increased risk of PAD but without history or physical examination findings suggestive of PAD, a measurement of resting ABI is reasonable. • Patients not at increased risk for PAD, and without history or physical examination findings suggestive of PAD, the ABI is NOT recommended. We soon discovered that although both Cone and ARMC appeared to be technically successful, the documentation was not adequate to use in the PVI Registry. Words like “widely patent”, and “successful” could not be translated into percentages. So our early technical success scores were low! NCDR’s crosswalk did not work for us, but we were allowed to create our own crosswalk if all of the vascular team would agree on the wording. Problem Recommendation Solution 0 20 40 60 80 100 Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Technical Success Cone ARMC National Results Using the Data to Spot Trends 3 4 2 7 3 5 8 1 0 5 2 4 0 3 5 2 2 2 2 2 2 2 2 2 0 1 2 3 4 5 6 7 8 9 Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Bleed or Major Vascular Complications Cone ARMC National A decline in P/O antiplatelet orders at ARMC was found to be a EMR glitch 91 88 94 98 95 90 93 94 93 75 85 89 78 58 85 80 85 95 95 96 96 97 97 97 97 96 0 10 20 30 40 50 60 70 80 90 100 Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Antiplatlet Therapy Ordered at D/C Cone ARMC National ACC recommends all PAD patients be on a statin at discharge, but his has not become a national trend. 0 10 20 30 40 50 60 70 80 90 100 Q1-15 Q2-15 Q3-15 Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Statins ordered at D/C Cone ARMC National ▪ Assesses the demographic, prevalence, provider and facility characteristics. ▪ Provides benchmarked decision making data on endovascular techniques and treatments ▪ Supplies outcome-based evidence for new treatments and medications ▪ Provides reports that compare our institutions performance with peer groups throughout the nation using the latest evidence based guideline. ▪ Promotes meaningful quality improvement opportunities ▪ Provides executive summaries that give a big picture review of quality data and provides for individual patient level drill downs. • Launched by American College of Cardiology in 2014 • The National Cardiology Data Registry is the data warehouse for the PVI Registry • Purpose is to address transition from open surgical model to percutaneous for peripheral vascular • disease (PVD) treatment • Registry assess prevalence, demographics, treatment and outcomes of patients with PVD • Enable physicians (MDs), hospitals, Centers for Medicare and Medicaid (CMS) and Federal • Drug Administration (FDA) to monitor safety and effectiveness of revascularization modalities. • Helps meet future demands of public reporting and appropriate use criteria for PVD patients PVI Registry Objectives Method/Data Collection: Retrospective Chart Review ▪ Medical History and Physical: nursing notes. doctors dictation, Care Everywhere, progress notes ▪ Pre-procedure Assessment: office documents, scanned documents, labs, radiology, vascular studies, wound center info ▪ Procedure: cath lab, OR, interventional radiology ▪ Complications: during procedure, post procedure, 30 days, 1 year follow-ups ABI is an abbreviation for ankle-brachial index and is an objective measurement of arterial insufficiency based on the ratio of ankle systolic pressure to brachial systolic pressure. 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