Overview on Project and Data Quality
description
Transcript of Overview on Project and Data Quality
Dallas County STEMI Market Performance
Data – Analytics – Q4 2010
Jim Langabeer II, PhDCenter for Emergency Research
University of Texas Health Science Center
Overview on Project and
Data Quality
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American HeartAssociation
Communities Foundation of Texas
AHA Caruth AMISystem Initiative
Dallas Stakeholder Committee
Raymond FowlerMichael Taylor
UT SouthwesternDallas
UT Health Science Center Houston
AHA Caruth Volunteer
Advisory BoardJames Langabeer
EMSResources
SubcommitteeKevin Cunningham
Craig White
ProtocolsSubcommittee
Chris ChiaraMark Till
EducationSubcommitteeKaren Pickard
Chris Weinzapfel
Quality ImprovementSubcommittee
Bob HillertTom Tierney
SymposiumPlanning
SubcommitteeJon GardnerTami Kayea
Jennifer Ledbetter
American College of Cardiology
Project Structure
• Data collection from ACC & EMS• Development of a central database• Comparison of EMS to hospital patient records• Data validation/integrity checks• Decision Support (data analysis) of STEMI
outcomes
UT Health - Role
• This is the inaugural report of the Dallas County STEMI system of care
• Use caution when interpreting these figures since they are strictly baseline for everybody involved!
• Data are for Oct 1 2010 to Dec 31 2010• Data collected from EMS agencies and
hospitals (through ACC Action Registry GWTG)
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Dallas Hospital Market
Overview to Methodology• Our primary focus is on collecting and
analyzing both pre-hospital (EMS) and hospital data for STEMI/NSTEMI in Dallas County
• To capture SOAR, we prefer to have complete records from time of 911 dispatch to hospital discharge
• We need to match EMS Hospital data, preferably using PCR or Incident #– For this quarter, we had to use DOB and incident
date/hospital arrival date since Aux3 field was not widely populated
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Overall Data Quality - Reminders
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•This project requires good data entry from both EMS & hospitals! • We cannot identify if 10-key entry errors exist• Lots of “null values”; for instance, several
patients had PCI=yes, but were missing device times or dates• EMS: arrival times at facility missing in many
cases• 24 hour time clock (e.g., 6 pm = 18:00)
Reporting Agencies Summary
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Organizations Received Missing
14 hospitals XX
Carrollton, Cedar Hill, Coppell, Dallas Fire, Desoto, Duncanville, Farmers Branch, Garland, Grand Prairie, Highland Park, Irving, Lancaster, Mesquite, Richardson, Rowlett, Sachse, Seagoville, Sunnyvale, and University Park
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Wilmer, Hutchins, Glenn Heights, CareFlite –Balch Springs, Addison
XX
Comment on EMS Data
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•Overall, we were not able to provide meaningful data analyses on most of the EMS data for Q4 due to •Missing data• Data quality, • Issues in EMS reporting• Data timing and integrity issues•We expect to have this resolved for Q1 2011
Patient PopulationQ4 2010
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Q4 2010 Patient Volumes
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•603 admissions in the NCDR/ACC registry• 594 unique patients
•15 participating hospitals • (we’ve received data for 14 this quarter)
•203 STEMIs noted (34% of all registry cases)
•129 STEMI, PCI, non-transfer cases in total• 123 Primary PCI form the population for all D2B and other timing outcomes
Patient Breakdown for Outcome Calculations
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Total Cases603
STEMI Noted203
NSTEMI400
To Cath. Lab167
(82% of STEMI)
No PCI36
Immediate Primary PCI;
150
Rescue PCI after lytics; 3
Stable successful reperfusion for
STEMI; 9 Other; 5
Patient Demographics
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Demographics Total Action GWTG
STEMI NSTEMI
Average Age 64 yrs 61 yrs 66 yrsMale 65% 68% 63%% Caucasian 71% 70% 72%% Black 20% 19% 21%% Hispanic Origin (of any race)
14% 17% 13%
Arrived by EMS 42% 46% 40%
Figures rounded for presentation purposes
STEMI Patient Volumes
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Oct-10 Nov-10 Dec-100
50
100
150
200
250
67 68 68
ACTION casesSTEMI patients
Transfer Patients – STEMI PCI Only
Non-Transfer; 129; 77%
Transfer from other facility;
38; 23%
STEMI Key Outcome Metrics 1
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1 non-transfer, STEMI, primary PCI only
Median Time (minutes)
SOAR 195D2B 74FMC2B 131E2B 72Time in Cath Lab 21Reperfusion Rate, PCI 82%
SOAR Analysis – Q4 2010Median time in Minutes
170
50
100
150
200
Onset to FMC (1st medical contact)
64
FMC to Door57
Door to ECG2
ECG to Cath51
Cath to Device 21
SOAR (Symptom Onset to Reperfusion)STEMI, Primary PCI, Non-Transfer
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H1
H4
H7
H2
H3 H5 H6
H14
H12
H11
H10
H8
H13
Median
TARGET
SOARSTEMI, Non-Transfer, Primary PCI Only
% of Cases in Each time category (n=121 complete)
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% of STEMI
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
<100; 10.6%
<200; 39.0%
<300; 16.3%<400; 5.7%
+400, 28.5%
Door to Balloon Times STEMI, Primary PCI only, Non-Transfers 1
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Median
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STEMI – Dallas County D2B OutcomesPrimary PCI, Non-Transfer Only
H1H2H3H4H5H6H7H8H9
H10H11H12H13
Most Consistently Low D2B (with least variability)
D2B Outcomes by Hospital
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1 Complete Cases Only (STEMI, Non-transfer, primary PCI only); 129 STEMI-PCI, 123 immediate PCI, 2 missing data)
2 Data witheld on cases for confidentiality purposes
Hosp.
Size/Volume Range (total cases)
# STEM
I Cases
STEMI (NT,
Primary PCI)
Mean D2B
Median D2B
Std Dev
Coef of Var Min Max
H1 <50 96.0 77.0 53.3 55.5% 53 225H2 <50 64.4 62.0 16.4 25.4% 46 97H3 >50 78.1 78.5 12.2 15.6% 60 109H4 >50 64.9 65.0 13.3 20.4% 38 85H5 <50H6 >50 104.0 74.5 110.0 105.0% 32 478H7 <50 90.3 77.5 37.0 40.9% 62 144H8 <50 105.0 95.0 47.1 44.9% 58 192H9 <50 66.1 65.5 28.9 43.7% 23 120H10 >50 70.0 71.0 14.1 20.2% 42 82H11 <50 66.8 59.5 30.7 46.0% 39 116H12 <50 114.0 50.0 139.0 122.0% 34 321H13 <50 165.0 104.0 153.0 92.9% 43 494H14 >50 76.7 77.5 30.6 39.9% 34 137H15 - -
Totals 603 203 121 1 85.5 74.0 64.7 75.7% 23 494
D2B Times STEMI, Non-Transfer, Primary PCI Only
% of Cases in Each time category (n=121 complete)
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<60 Mins61-90 Mins
91-120 Mins>2 hours
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
25.6%
53.7%
11.6%9.1%
STEMI Outcomes
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•The shortest D2B time was 23 Minutes
•Average length of stay for all STEMI (non-transfer, primary PCI) patients was 3.6 days
•We had 9 deaths in the STEMI population (4.4%)