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The PINNACLE Registry QI/QA tool for cardiology trainees

The PINNACLE Registry QI/QA tool for cardiology trainees. Dr. Hank Rosman Clinical Cardiology Fellowship Program Director Dr. Melissa Frederick Clinical Cardiology Fellow St. John Hospital and Medical Center Detroit, MI. PINNACLE Registry. ACC designed (NCDR)

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The PINNACLE Registry QI/QA tool for cardiology trainees

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  1. The PINNACLE RegistryQI/QA tool for cardiology trainees Dr. Hank Rosman Clinical Cardiology Fellowship Program Director Dr. Melissa Frederick Clinical Cardiology Fellow St. John Hospital and Medical Center Detroit, MI

  2. PINNACLE Registry • ACC designed (NCDR) • First cardiology ambulatory registry • 4 most common cardiac conditions • HTN • CAD • CHF • Atrial fibrillation

  3. PINNACLE Registry • Designed to assist practices to: • Quality care improvement (QI) by reducing inappropriate variations in care • Eliminate gaps in care • Improve care coordination for patients with cardiovascular diseases

  4. PINNACLE Registry NCDR registries also used for research and publications No mention of use by Medicare or large insurance companies as report cards to reward or punish groups or individual physicians

  5. PINNACLE Network • Three components: • PINNACLE Registry • Nation’s largest cardiovascular ambulatory quality improvement registry • PINNACLE Network Portfolio • Organized set of programs, tools, and services for cardiovascular practices • Interactive community of peers • Committed to delivering coordinated, efficient, safe and effective cardiovascular care for their patients • Share experience with others

  6. Data collection Paper forms – completed and faxed EHR extraction Manually entering on computer

  7. Is PINNACLE an opportunity to advance cardiology fellows’ training? • Patient outcomes • Guideline adherence • Teach PBL/SBL • Assess and address gaps

  8. Fellows’ participation in the PINNACLE Registry • 9/09-6/10 • Pilot- voluntary participation • 7/10-present • Full (compulsory) participation • Data collection forms completed by hand • 6/10 & 1/11 • Fellows surveyed re: PINNACLE experience • 11/15/10 • Quarterly data report from PINNACLE

  9. Data Gathering • 1/14-1/20/2011 • 52 patient encounters (5.8 pts/clinic) • Average time to complete form: • 5 minutes (4-6 range) • Errors: • None 37/52 72% • 1 9/52 17% • Examples: • Lipid value or EF% missing in 7 • Vital signs missing in 3

  10. Evaluation of performance measures • Performance of quality indicators • 28 Practice indicators St. John vs national • Above 25/28 • At 1/28 • Below 2/28

  11. Apparent gaps

  12. Apparent excellence

  13. Survey Results Fellows perception of the following: 0n a scale from 0 (no impact) to 10 (more significant impact)

  14. QI Process • Review 2010 3rd quarter report (rec’d 11/15/10) • Identify apparent gaps • Verify accuracy • Develop improvement plan • Re-measure from 2/15/11 report

  15. Case study #1

  16. M.A.F.

  17. Accurate?

  18. Chart review • Registry report: • Individual: 24/29 (83%) • (All fellows 94%, national 86%) • Chart review: • Reviewing saved PINNACLE forms 16/19 (84%) • Reviewed 3 patients’ charts: 18/19 (95%) • Flaw in office medication review

  19. Case study #2

  20. M.A.F.

  21. M.A.F.

  22. Chart review • Lipid profile: • 19/19 (100%) had lipids done (12) or ordered (7) at that visit • Lipid-lowering medications: • 16/19 (84%) from DCF review • 2 not on because of weakness/myalgias • 1 not on because 90 y/o in NH

  23. Case study #3

  24. Results by Fellowship Year

  25. Summary • Participation in the PINNACLE Registry is recommended as it helps fellows: • Structure clinic visits • ID key clinical parameters for 4 cardiac conditions • Measure key practice/system based learning • Improve a registry of National Importance

  26. Science Fiction Scenario #12015 Report to Group Leader or Hospital About YouMarch 2015 Dr. Rosman’s Quarterly Report from 9/2014 – 12/2014 shows the following deficiencies: • % with appropriate antiplatelet RX, 83% National Average, 92% National Standard, 95% • % with appropriate lipid measures, 34% National Standard, 90% Therefore: • Your group will not receive quarterly bonus • Your report card is public record (on AETNA.com) • Without improvement by 9/1/15, you can lose hospital privileges

  27. Science Fiction Scenario #22015 Office Note (EHR) on Patient Visit 3/1/15 Dr. Rosman prescribes statin by Internet RX “Pop-Up” on screen: • Last Lipid Profile 2/1/2014 • Do you wish to Rx Fasting Lipid Profile and SGOT? Dr. Rosman clicks “close” on Internet RX “Pop-Up” on screen: • Your patient has DX of coronary artery disease, S/P CABG • Your Med Sheet shows no antiplatelet Rx. Do you wish to order aspirin and/or clopidogrel?

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