What Are You Doing With Your Registry Data?

The synopsis of this article is by courtesy of ACC
By Robert N. Vincent, MD, CM, FACC, Chair of the ACC's IMPACT Registry Steering Committee

The ACC's IMPACT Registry is a vehicle to collect data on all pediatric and adult patients with congenital heart disease undergoing diagnostic and interventional catheterization procedures. Its key objective is to collect data to identify variability in procedures amongst institutions and operators, link variability to outcomes, assess performance, provide benchmarks and implement quality improvement initiatives. The intent is to improve the care and outcome of patients with congenital heart disease undergoing cardiac catheterization.

Quarterly reports consisting of the last 12 months of data are distributed to participating institutions. They contain center-specific data and aggregate data for all metrics and data elements. Individual institutions are able to compare their data and outcomes to aggregate data, but not to other specific institutions. We recommend centers consider the five "W's" below when evaluating the quarterly report.

Who: Who is looking at them? Unless all involved personnel are present (physicians, nurses, technicians, administrators, etc.) and active in the discussion of the report, there won't be a meaningful discussion about quality improvement. Good data are dependent on good data entry. Who is responsible for data entry and data oversight?

What: What are you looking at? Are you looking at the quality metrics and analyzing what these numbers really mean to you and your institution? Do they reflect what is happening within your institution? Are the data correct or have there been data entry errors? They can be fixed. If you identify a problem within the registry outcomes report that you think results from a programming issue, this needs to be relayed to the NCDR. Hospital feedback enhances the quality of reporting.

When: Are there regularly scheduled meetings; do all relevant parties attend? Is there a discussion and exchange of ideas or just a review of the report? Are you comparing your results to previous results and looking at areas with declining performance as well as areas showing improvement, or just comparing to benchmarked data? The intent of a regularly scheduled meeting is to keep quality on everyone's mind.

Where: Does the meeting location have access to all information needed for discussions that might occur? It is important to have access to the quarterly report, EMR, quality score cards, as well as catheterization, CT, echocardiogram, MRI reports and images, etc. When questions about specific issues are raised, is the meeting located where you can retrieve the information to answer them?

Why: Why quality improvement? The answer should be to provide patients with the best cardiovascular care possible. You should be comparing yourself to aggregate data for benchmarking, but more importantly to yourself for improvement.

It is not uncommon for centers to look at the data, compare themselves to the benchmark, see that they fall within the expected ranges, and be happy with that. An alternative is to pick one or two areas that you wish to improve and analyze these internally to see how you are doing. Quality improvement occurs over time and must be evaluated along a continuum so that these data become reflective of what is truly happening in your institution. This is particularly true for rare events that occur in uncommon cases (which are the majority of the cases that we do in congenital cardiology).