Case Study in Collaboration: Helping a Health System Integrate Its Cardiac Registry Data Flow

As detailed previously on Consult QD, Cleveland Clinic’s Miller Family Heart & Vascular Institute has built a network of affiliated and allied provider organizations across the U.S. to share best practices and help these organizations enhance their cardiovascular programs from clinical, operational and strategic perspectives. This post profiles how Cleveland Clinic’s relationship with one such partner organization, MedStar Heart & Vascular Institute, helped that organization improve one key aspect of its informatics operations.

The challenge: Centralizing the cardiac registry information flow

Cleveland Clinic formed a clinical and research alliance in early 2013 with MedStar Heart & Vascular Institute, which serves a large population in the Maryland and Washington, D.C., region.

At the time, MedStar’s registry data collection process benefited from experienced cardiac surgery data abstractors and a solid IT infrastructure. However, there were multiple opportunities to align and integrate its two major repositories of registry information — for cardiac surgery and interventional cardiology — to provide more efficient, timely, accurate, validated, actionable and personal information to the clinical teams for quality process improvement.

To meet these challenges, MedStar leadership enlisted Cleveland Clinic’s support to create an integrated and centralized cardiovascular registry and quality process to accurately collect, validate, analyze and communicate results across the clinical disciplines and engage physicians in quality improvement initiatives. The broader aim was to provide a base for programmatic improvement and allow the health system to publish quality and outcome metrics to demonstrate overall service capabilities and value.

Approach and solutions

Beginning with its Washington Hospital Center, MedStar implemented the specific changes outlined below. At every step, its efforts were guided by administrative and clinical advisors from Cleveland Clinic, who shared processes and insights from their own experience with similar initiatives at Cleveland Clinic.

• Developed an integrated cardiovascular service line registry and quality dashboard. After multiple iterations, an integrated cardiovascular service line quality dashboard has been produced and is reviewed on a routine basis. The dashboard includes specified core measures, patient safety indicators, readmission and mortality measures, and executive summary metrics from the national registry reports for cardiac surgery, percutaneous coronary intervention (PCI) procedures and implantable cardioverter-defibrillator procedures.
• Began integration of registry and quality personnel into a centralized structure to optimize and standardize data collection, validation, analysis and communication and to enable improved cost management. This centralization of structure and processes promotes physician and staff engagement and aligns with cardiovascular service line quality goals.
• Began holding quality meetings with a multidisciplinary team from both MedStar and Cleveland Clinic. Discussions revolve around metric results review, the strategic priority of specific metrics and process changes to improve metrics.

Outcomes so far

MedStar has seen some early successes in the wake of these changes, including a substantial decline in risk-adjusted mortality after aortic valve replacement (Figure 1) and a marked increase in use of the radial artery for PCI procedures (Figure 2), which decreases bleeding complications, reduces length of stay and increases patient satisfaction.

Additional outcomes of the initiative include:

• An integrated quality dashboard that aligns across MedStar’s cardiovascular service line
• Newly instituted interdisciplinary quality meetings involving staff from the Heart & Vascular Institutes of both MedStar and Cleveland Clinic
• Progress toward reorganizing quality and registry personnel into a centralized, integrated and aligned structure across the cardiovascular service line

MedStar’s take on the collaboration

“Partnering with Cleveland Clinic has given us the opportunity to focus our physicians and staff on fostering a transparent, outcomes-based environment while also allowing us to benchmark ourselves against the best heart program in the world,” says Allen Taylor, MD, Chief, Division of Cardiology, MedStar Heart & Vascular Institute. “To help us get there, they shared best practices around implementation of a high-quality data and informatics program, which enabled us to obtain clean data that we could act on. And the ongoing collaboration on developing a pathway to performance transformation provides tremendous value to our organization.”