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Dallas County STEMI Market Performance Data – Analytics – Q4 2010 Jim Langabeer II, PhD Center for Emergency Research University of Texas Health Science Center. Overview on Project and Data Quality . Project Structure. American Heart Association. Communities Foundation of Texas.

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Overview on project and data quality

Dallas County STEMI Market PerformanceData – Analytics – Q4 2010Jim Langabeer II, PhDCenter for Emergency ResearchUniversity of Texas Health Science Center


Overview on project and data quality

Overview on Project

and

Data Quality


Overview on project and data quality

Project Structure

American Heart

Association

Communities Foundation

of Texas

AHA Caruth AMI

System Initiative

UT Health Science

Center Houston

AHA Caruth

Volunteer

Advisory Board

James Langabeer

UT Southwestern

Dallas

Dallas Stakeholder

Committee

Raymond Fowler

Michael Taylor

American College of Cardiology

Education

Subcommittee

Karen Pickard

Chris Weinzapfel

EMS

Resources

Subcommittee

Kevin Cunningham

Craig White

Protocols

Subcommittee

Chris Chiara

Mark Till

Symposium

Planning

Subcommittee

Jon Gardner

Tami Kayea

Jennifer Ledbetter

Quality

Improvement

Subcommittee

Bob Hillert

Tom Tierney


Overview on project and data quality

UT Health - Role

  • 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


Overview on project and data quality

Dallas Hospital Market

  • 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)


Overview to methodology

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


Overall data quality reminders

Overall Data Quality - Reminders

  • 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

Reporting Agencies Summary


Comment on ems data

Comment on EMS Data

  • 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


Overview on project and data quality

Patient Population

Q4 2010


Q4 2010 patient volumes

Q4 2010 Patient Volumes

  • 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

Patient Breakdown for Outcome Calculations

Total Cases

603

STEMI Noted

203

NSTEMI

400

To Cath. Lab

167

(82% of STEMI)

No PCI

36


Patient demographics

Patient Demographics

Figures rounded for presentation purposes


Stemi patient volumes

STEMI Patient Volumes


Transfer patients stemi pci only

Transfer Patients – STEMI PCI Only


Stemi key outcome metrics 1

STEMI Key Outcome Metrics 1

1 non-transfer, STEMI, primary PCI only


Soar analysis q4 2010 median time in minutes

SOAR Analysis – Q4 2010Median time in Minutes


Soar symptom onset to reperfusion stemi primary pci non transfer

SOAR (Symptom Onset to Reperfusion)STEMI, Primary PCI, Non-Transfer

H12

H7

H11

H14

H1

H8

Median

H5

H6

H4

TARGET

H3

H10

H13

H2


Soar stemi non transfer primary pci only of cases in each time category n 121 complete

SOARSTEMI, Non-Transfer, Primary PCI Only% of Cases in Each time category (n=121 complete)


Door to balloon times stemi primary pci only non transfers 1

Door to Balloon Times STEMI, Primary PCI only, Non-Transfers 1

Median


Overview on project and data quality

STEMI – Dallas County D2B Outcomes

Primary PCI, Non-Transfer Only

Most Consistently Low D2B (with least variability)


D2b outcomes by hospital

D2B Outcomes by Hospital

Complete Cases Only (STEMI, Non-transfer, primary PCI only); 129 STEMI-PCI, 123 immediate PCI, 2 missing data)

Data witheld on cases for confidentiality purposes


D2b times stemi non transfer primary pci only of cases in each time category n 121 complete

D2B Times STEMI, Non-Transfer, Primary PCI Only% of Cases in Each time category (n=121 complete)


Stemi outcomes

STEMI Outcomes

  • 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%)


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