Abstract 16785: Student Abstractors Reduce the Cost of Registry Use Without Compromising Quality

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nasser Lakkis ◽  
Allison P Capetillo ◽  
Cherie S Boxberger ◽  
Stephanie Chapman
Keyword(s):  
Heart Failure ◽  
Heart Association ◽  
Primary Diagnosis ◽  
Successful Implementation ◽  
Clinical Registry ◽  
Program Manager ◽  
Part Time ◽  
Get With The Guidelines ◽  
The Cost ◽  
Physician Support

Introduction: Accurate data abstraction is the cornerstone of successful implementation of Get With The Guidelines-Heart Failure, but abstraction costs are the single largest barrier to participation. Objective: The Heart Failure Abstraction Internship was established to test the efficacy of part-time, graduate students as GWTG-HF abstractors in comparison to a registered nurse using an acceptable Data Element Agreement Rate (DEAR). Methods: The selection criteria for the pilot hospital, Ben Taub Hospital, Houston Texas was: not a GWTG-HF participant; serving diverse populations; administrative and physician support and available supervision for interns. Intern abstractors were recruited and paid as American Heart Association (AHA) employees. For the pilot term, the interns were onboarded as volunteers for the pilot hospital. They met the onboarding requirements of AHA and the pilot institution’s requirements for hospital volunteers. The interns; worked on-site at the pilot institution; were given computer access to EPIC electronic medical records and GWTG-HF; were trained by AHA Quality staff and the pilot hospital Cardiology Program Manager; and abstracted all patients with a primary diagnosis of heart failure from October 2017 to December 2018. An AHA nurse auditor virtually re-abstracted 5 records with the pilot, Cardiology Program Manager. The audit was conducted using the July 2018 Clinical Registry Form (CRF) that was also used during the pilot. Results: The intern abstractors matched the re-abstractor at a DEAR of 86.4% with 340 total elements and 46 mismatches. Conclusions: The hypothesis was proven with a DEAR of 86.4%, suggesting hospitals can be successful participants in GWTG utilizing student abstractors for data collection needs. The median payrate for a nurse abstractor is $24.50 per hour, not including benefits*. The rate for part time employment for the abstraction interns was $10.00 per hour. In addition to financial savings for the pilot organization, the interns worked efficiently as they focused on one task allowing the clinical team to focus on process improvement based on the data collected. This PI focus led to other outcome improvements including reduced readmission and increased compliance with GDMT. *Payscale.com

Abstract 377: Characteristics, Care, and Outcomes of Asian American Heart Failure Patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Feng Qian ◽  
Gregg C Fonarow ◽  
Selim R Krim ◽  
Rey P Vivo ◽  
Margueritte Cox ◽  
...  
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Asian American ◽  
American Heart ◽  
Heart Association ◽  
Quality Measures ◽  
Clinical Profiles ◽  
Get With The Guidelines ◽  
White Patients

Background: Because little is known about Asian American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. Methods: We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3,774 Asian Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program between January 1, 2005 and December 31, 2012. Baseline characteristics, achievement measures, composite “all-or-none” care (proportion receiving all eligible achievement measures), quality measures, in-hospital mortality, discharge to home, and length of stay were examined. Results: Relative to white patients, Asian American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency. At admission, they had higher heart rate, systolic blood pressure, B-type natriuretic peptide, serum creatinine, and blood urea nitrogen. Overall, Asian American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk , 0.88; 95% confidence interval , 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Asian American patients had lower unadjusted rate than white patients in terms of implantable cardioverter defibrillators (ICD) counseling (32.7% versus 48.1%) and ICD placed/prescribed at discharge (33.8% versus 50.6%). However, these differences were not statistically significant after risk adjustment for patient and hospital characteristics. Compared with white patients, Asian American patients had comparable in-hospital mortality, length of stay, and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11) (Table). Conclusion: Despite some differences in clinical profiles, Asian American HF patients receive very similar quality of care and have comparable or even better health outcomes than white patients. This study suggests that focusing on 2 specific quality measures might further improve HF care for Asian Americans.

Abstract 35: Predictors and Etiologies of 30-Day Readmission Rate in Patients With Pulmonary Embolism: A National Population-Based Cohort Study

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Saman Setareh-Shenas ◽  
Alejandro Lemor ◽  
Daniel Castaneda Mayorga ◽  
Alonso Alvarado ◽  
Eyal Herzog
Keyword(s):  
Heart Failure ◽  
Pulmonary Embolism ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
Primary Diagnosis ◽  
Healthcare Research ◽  
Cost Of Care ◽  
Elderly Age ◽  
Readmission Rates ◽  
The Cost

Background: The hospitalization rates of patients with pulmonary embolism (PE) has been on the rise. However, there is limited data recognizing the etiologies and predictors of early readmission rate in this patient population. Methods: We utilized the National Readmission Database (NRD) 2013, subset of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). PE was identified using ICD 9 code (415.1X) as primary diagnosis. Co-morbidities identified by “CM_” variables provided by NRD. Primary outcome was identified as predictors of 30-day readmission rates and secondary outcomes as the leading etiologies and trends of readmission rate. To identify predictors of outcome, a two level hierarchical logistical model was used. Results: We analyzed 76,994 patients with primary diagnosis of PE. Total of 11.6% (8,934) patients were readmitted within 30 days of index hospitalization. Significant predictors of readmission were associated with end stage renal disease, drug abuse, chronic lung disease, congestive heart failure, and gastrointestinal bleed during primary admission. In addition, female gender, those admitted to teaching hospital and with longer length of stay (LOS) had higher 30-day readmission rate. Remarkably, elderly age (age>75 years) was not associated with increase in readmission rates. The leading etiologies besides DVT/PE for readmission were sepsis/septic shock, cancer, heart failure and pneumonia. Conclusion: The rising hospitalization rate of patients with pulmonary embolism, imposes a higher burden on the cost of health care. We identified important predictors and etiologies of 30-day readmission rate. These findings may help in prevention of hospital readmissions and may decrease the cost of care.

Abstract 346: Use of Aldosterone Antagonists at Discharge in Eligible Heart Failure Patients With a Comprehensive Heart Failure Program: Trends in Compliance With Get With the Guidelines-Heart Failure

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ryan J Maybrook ◽  
Muhammad R Afzal ◽  
Audra Rankin ◽  
Christy Russell ◽  
James Vacek
Keyword(s):  
Heart Failure ◽  
Compliance Rate ◽  
Severe Heart Failure ◽  
Heart Association ◽  
Outcome Data ◽  
Categorical Variables ◽  
Major Barrier ◽  
Aldosterone Antagonists ◽  
Significant Difference ◽  
Get With The Guidelines

Background: Use of aldosterone antagonist (AA) therapy is a class I recommendation in moderate to severe heart failure (HF). Multiple studies have reported the underutilization of AA in eligible patients. We wished to analyze determining factors for this ongoing underutilization using the AHA’s Get With the Guidelines (GWTG) HF database from American Heart Association (AHA). We hypothesized that elevated creatinine is a major barrier to use of AA. Methods: A comprehensive HF program utilizing the GWTG measures was recently established at our institution. Outcome data utilizing the GWTG registry from January 2009 to June 2012 was analyzed. Given ACC/AHA guidelines that creatinine should be < 2.5 mg/dL in men or < 2.0 mg/dL in women, we chose to analyze genders separately. To analyze effect of degree of creatinine elevation on AA therapy at discharge, two subcategories of creatinine levels were analyzed. Creatinine levels above 2.0 mg/dL in women and 2.5 mg/dL in men were excluded, as AAs are contraindicated in these patients. Categorical variables were compared using the chi-square test. Results: Our total compliance rate with AA therapy at discharge during the study period was 26% (149 of 565) for females and 31% (199 of 640) for males. There was no significant decline in compliance when creatinine levels were >1 mg/dL. Additionally, when comparing rates of compliance according to creatinine level across gender, there was no statistically significant difference in the use of AAs (see Table). Conclusion: Overall, AA therapy compliance at discharge at our center, as well as a majority of nationally recognized HF center participating in GWTG-HF registry remains suboptimal, irrespective of gender. This is despite known data that has clearly shown AAs significantly reduce mortality, cardiovascular death, HF hospitalizations and the composite endpoints. In contrast to prior studies, mild creatinine elevation does not seem to be a significant barrier to presciption of AAs. It is possible that other variables such as polypharmacy, hyperkalemia and effects of dual blockade of the renin-angiotensin-aldosterone system and the possibility of endocrine side effects associated with the non-selective AAs may be playing a role. More aggressive and consistent use of AA therapy for HF is warranted.

Abstract 13008: Combined Assessment of American Heart Association Get With the Guidelines-heart Failure Risk Score With Plasma D-dimer and N-terminal Pro-b-type Natriuretic Peptide Levels Improves Prediction of Mortality in Patients Hospitalized for Worsening Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hiroyuki Naruse ◽  
Junichi Ishii ◽  
Hideto Nishimura ◽  
masaya ohta ◽  
Hideki Kawai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Risk Score ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Net Reclassification Improvement ◽  
Prediction Of Mortality ◽  
Get With The Guidelines ◽  
D Dimer

American Heart Association Get With the Guidelines-Heart Failure (GWTG-HF) risk score is a useful multivariable score model to predict mortality in patients with acutely decompensated heart failure. We prospectively investigated the prognostic value of combined assessment of GWTG-HF risk score with D-dimer and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Methods: On admission, we measured plasma D-dimer and NT-proBNP levels in 1735 patients (mean age, 75 yrs) hospitalized for worsening heart failure. GWTG-HF risk score, including race, age, systolic blood pressure, heart rate, blood urea nitrogen level, sodium concentration, and presence of chronic obstructive pulmonary disease, was calculated at admission. Results: During a follow-up period of 12 month after admission, 371 (21%) deaths occurred. Patients who died were older (mean: 78 vs. 74 years; P<0.001), had a higher frequency of NYHA functional class IV (63 vs. 49%; P<0.001), higher values of GWTG-HF risk score (43 vs. 38; P<0.001), D-dimer (2.90 vs. 1.30 μg/mL; P<0.001), and NT-proBNP (7202 vs. 3689 pg/mL; P<0.001) than survivors. In the multivariate logistic analysis, elevation (more than the highest tertile value) in D-dimer (>2.5 μg/mL; P<0.001), NT-proBNP (>7399 pg/mL; P<0.001), and GWTG-HF risk score (>42 point; P<0.001) were independently associated with mortality within 12 months. Furthermore, adding D-dimer and NT-proBNP to the GWTG-HF risk score improved the C-index (P<0.01), net reclassification improvement (P<0.001), and integrated discrimination improvement (P<0.001) greater than GWTG-HF risk score alone. The number of elevation in GWTG-HF risk score, D-dimer, and NT-proBNP was strongly associated with a higher risk of mortality within 12 months ( Figure ). Conclusion: The combined assessment of GWTG-HF risk score with D-dimer and NT-proBNP facilitates the risk stratification for mortality within 12 months in patients hospitalized for worsening heart failure.

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