“The future of medicine is increasingly in the hands of those who are effective users of clinical data.”
So wrote Bill Weintraub, MD, FACC, “grandfather” of the National Cardiovascular Data Registry (NCDR), et al (J Am Coll Cardiol 1997;29:459-465). Established in 1998, the CathPCI Registry is the oldest registry under the American College of Cardiology’s NCDR umbrella. Designed to assess the characteristics, treatments and outcomes of cardiac disease patients who receive diagnostic catheterization and PCI procedures, the CathPCI Registry has grown into the largest ongoing contemporary database of PCI procedures (J Am Coll Cardiol 2001;37:2240-2245, J Am Coll Cardiol 2012;60:2017–2031).
At the time, many healthcare experts debated if metrics, data collection and outcomes analysis could improve the quality of healthcare. The development of the CathPCI Registry was the College's attempt to answer this question. Since then, the CathPCI Registry has grown from 75 hospitals in its first year to more than 1,620 sites, nearly 90 percent of cardiac catheterization labs in the U.S. Most recently, the registry gained international traction with sites in Brazil, Saudi Arabia and the United Arab Emirates.
The success and growth of the registry also can be credited to influencers like payers, purchasers, the Centers for Medicare & Medicaid Services (CMS) and other specialty cardiovascular societies. Once health plans and local initiatives converted to using the CathPCI as a platform, people started to take notice. An important tipping point for CathPCI Registry acceptance was the National Quality Forum’s approval and endorsement of the NCDR’s in-hospital risk-adjusted mortality outcomes measure.
For 15 years, the registry has provided participants with quality benchmarking data on individual hospital performance compared to the national aggregate. To date, the registry's collection of patient data—more than 14 million patient records from participating hospitals, free-standing laboratories and adult cardiology practices—has been used to measure and quantify quality improvement in order to best manage cardiovascular care.
CathPCI Registry data have played key roles in helping reduce door-to-balloon times; controlling costs associated with preventable procedural complications; limiting hospital readmissions; and more. In addition, more than 100 studies published in peer-reviewed journals have used data from the registry. Based on the success of the CathPCI Registry, the ACC has added six additional registries to the NCDR suite.
A major milestone for the CathPCI Registry was the recent launch of a physician dashboard for participants. This free member benefit includes more than 40 physician-level metrics generated from CathPCI Registry data. In addition, the overall outcomes reports have evolved to incorporate appropriate use criteria (AUC) metrics based on the College’s AUC for coronary revascularization that allow hospitals to track and benchmark their information with other hospitals in the U.S. Hospitals also can identify opportunities to improve the selection of patients who receive PCI by using the “institutional rates of procedural appropriateness” data included in the report.
This past July, CathPCI participating hospitals were able to voluntarily report their 30-day PCI readmission measure results on the CMS Hospital Compare website.
A new version of the CathPCI Registry is being built to address the changes in AUC and additions of other metrics to the registry. In addition, the following are goals for the registry:
- Be a source for quality measurement and reporting;
- Improve outcomes and appropriate use of treatments and devices;
- Enrich and expand guideline recommendations;
- Provide device surveillance and pre/post market studies;
- Inform coverage decisions; and
- Assist with meeting maintenance of certification and other continuing medical education requirements.
Achieving these goals will not be without challenges. However, the registry continues to improve, thanks to NCDR volunteers, staff, hospitals and cardiovascular professionals.
Dr. Brindis is senior medical officer of external affairs for the NCDR and is a professor at the University of California, San Francisco.