Revisiting Registry Reporting Practices Bolsters Quality Metrics for an Allied Hospital

The Parkview Heart Institute (PHI) at Parkview Regional Medical Center, Fort Wayne, Indiana, is the only dedicated heart hospital in its region. Beginning in August 2019, PHI entered into an alliance with Cleveland Clinic’s Heart, Vascular & Thoracic Institute to advance care quality and efficiencies for its cardiovascular patients.

A focus on registry submissions

An early focus of the alliance was PHI’s processes for data collection, coding and management for the various cardiac registries in which PHI participates. The PHI registry team was highly engaged and qualified, but the hospital’s performance on some registry quality metrics wasn’t satisfactory. Initial consultation from a clinical analyst with Cleveland Clinic Heart and Vascular Advisory Services identified registry data submission as a likely contributing factor to performance shortfalls.

In response, PHI committed to providing oversight of all cardiac registries and ensuring high-quality data abstraction and reporting. “Robust data collection and registry management are key to driving quality improvement,” says Megan Gibas, BS, CPHQ, the data quality metrics manager who leads the PHI registry team. “Early discussions with Cleveland Clinic Heart and Vascular Advisory Services staff revealed that we had opportunities to do restructuring and adopt some best practices to facilitate efficient, real-time data abstraction and reporting for our registries.”

Review reveals opportunities for improvement

Gibas and the PHI registry team worked closely with a Cleveland Clinic clinical analyst to conduct a thorough review of the abstraction and reporting processes for all PHI registries. They started with the ICD Registry™ of the American College of Cardiology’s (ACC) National Cardiovascular Data Registry (NCDR®) and discovered crucial abstracting practices that were impacting PHI’s data reporting and influencing its performance on the registry’s device-based therapy guideline metrics.

Example 1. For instance, PHI ranked below the 50th percentile of all registry participants on ICD Registry guideline metrics. Yet when PHI’s electrophysiology physician champion reviewed the records of patients identified as not meeting indications for ICD implantation, he determined that they did indeed meet the indications.

Detailed review revealed that most of these patients were classified as not meeting indications because they were coded as not having ventricular tachycardia (VT). Further review showed that this was because patients with certain special circumstances that qualify for coding as VT — such as ventricular fibrillation arrest — were not being coded as VT. A previous frequently asked question (FAQ) from the NCDR registry provided clarification and proper instruction on how to capture this data point moving forward.

Example 2. Another issue discovered was that data elements required by the ICD Registry were sometimes missing from physician charting of cases. While PHI’s electronic medical record (EMR) offered structured reporting, utilization was not required. At Cleveland Clinic’s recommendation, PHI physician leadership made use of structured reporting mandatory for device implantation cases. The policy not only ensured accurate documentation for the EMR but also supplied many of the missing elements required by the registry.

As a result of these and other changes to the data collection and abstracting process, PHI’s quarterly adherence rate for ICD Registry guideline metric 25 improved from 63.9% to 100% in less than a year, and the quarterly adherence rate for metric 26 rose from 53.3% to 100% in the same period. Gibas presented these and other positive results from the initiative in a poster at the virtual ACC Quality Summit in October 2020.

Learnings applied to additional registries

The Cleveland Clinic and PHI teams have subsequently reviewed PHI’s practices for other cardiac registries to ensure accurate and timely abstraction. The initial review of the ICD Registry prompted the PHI team to conduct more frequent data submissions to the NCDR, which allows them to review any metric fallouts and thoroughly review data ahead of submission deadlines.

The result has been improved outcomes in all NCDR registries. For example, PHI saw an improvement in the class I/class II guideline requirement in the Afib Ablation Registry™ as well as more accurate capture of complications. In the coming year, a thorough review of abstraction and reporting for the Society of Thoracic Surgeons Adult Cardiac Surgery Database will be undertaken.

Collaboration continues

Cleveland Clinic and PHI teams continue to hold quarterly quality meetings via videoconference for various specialty areas, including cardiac surgery, the catheterization lab, electrophysiology and, beginning in 2021, transcatheter aortic valve replacement. These meetings include data reviews and discussion of clinical best practices, and they involve physicians, clinical consultants and the clinical analyst from Cleveland Clinic’s Heart, Vascular & Thoracic Institute as well as physicians, nurse leaders, administrators, and data and registry managers from PHI.

“The collaboration between the Cleveland Clinic and PHI teams allowed for the creation of a timely workflow for abstraction to national registries with improved accuracy to reflect the high-quality care the PHI provides to the Fort Wayne community,” says Christopher Bajzer, MD, one of the Cleveland Clinic cardiologists involved in those meetings.

“This alliance has been instrumental in our registry and quality program development,” adds PHI’s Gibas. “Implementing best practices shared by Cleveland Clinic has created a robust quality program at Parkview Heart Institute that will continue to ensure the best patient care and outcomes.”

“Our collaboration with Cleveland Clinic is oriented to the direct improvement and advancement of patient care,” says Roy Robertson, MD, President, Parkview Heart Institute. “Our joint efforts around data collection and registry management have provided information to help our teams advance the level of care to new heights. Working alongside Cleveland Clinic has facilitated many best practices and prompted some helpful restructuring. We look forward to continued collaboration.”

For information on affiliation and alliance opportunities with Cleveland Clinic’s Heart, Vascular & Thoracic Institute, email Amanda Lesesky at leseska@ccf.org.