Dallas County STEMI Market Performance

Data – Analytics – Q4 2010

Jim Langabeer II, PhDCenter for Emergency Research

University of Texas Health Science Center

Overview on Project and

Data Quality

2

American HeartAssociation

Communities Foundation of Texas

AHA Caruth AMISystem Initiative

Dallas Stakeholder Committee

Raymond FowlerMichael Taylor

UT SouthwesternDallas

UT Health Science Center Houston

AHA Caruth Volunteer

Advisory BoardJames Langabeer

EMSResources

SubcommitteeKevin Cunningham

Craig White

ProtocolsSubcommittee

Chris ChiaraMark Till

EducationSubcommitteeKaren Pickard

Chris Weinzapfel

Quality ImprovementSubcommittee

Bob HillertTom Tierney

SymposiumPlanning

SubcommitteeJon GardnerTami Kayea

Jennifer Ledbetter

American College of Cardiology

Project Structure

• 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

UT Health - Role

• 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)

5

Dallas Hospital Market

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

6

Overall Data Quality - Reminders

7

•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

8

Organizations Received Missing

14 hospitals XX

Carrollton, Cedar Hill, Coppell, Dallas Fire, Desoto, Duncanville, Farmers Branch, Garland, Grand Prairie, Highland Park, Irving, Lancaster, Mesquite, Richardson, Rowlett, Sachse, Seagoville, Sunnyvale, and University Park

XX

Wilmer, Hutchins, Glenn Heights, CareFlite –Balch Springs, Addison

XX

Comment on EMS Data

9

•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

Patient PopulationQ4 2010

10

Q4 2010 Patient Volumes

11

•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

12

Total Cases603

STEMI Noted203

NSTEMI400

To Cath. Lab167

(82% of STEMI)

No PCI36

Immediate Primary PCI;

150

Rescue PCI after lytics; 3

Stable successful reperfusion for

STEMI; 9 Other; 5

Patient Demographics

13

Demographics Total Action GWTG

STEMI NSTEMI

Average Age 64 yrs 61 yrs 66 yrsMale 65% 68% 63%% Caucasian 71% 70% 72%% Black 20% 19% 21%% Hispanic Origin (of any race)

14% 17% 13%

Arrived by EMS 42% 46% 40%

Figures rounded for presentation purposes

STEMI Patient Volumes

14

Oct-10 Nov-10 Dec-100

50

100

150

200

250

67 68 68

ACTION casesSTEMI patients

Transfer Patients – STEMI PCI Only

Non-Transfer; 129; 77%

Transfer from other facility;

38; 23%

STEMI Key Outcome Metrics 1

16

1 non-transfer, STEMI, primary PCI only

Median Time (minutes)

SOAR 195D2B 74FMC2B 131E2B 72Time in Cath Lab 21Reperfusion Rate, PCI 82%

SOAR Analysis – Q4 2010Median time in Minutes

170

50

100

150

200

Onset to FMC (1st medical contact)

64

FMC to Door57

Door to ECG2

ECG to Cath51

Cath to Device 21

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

18

H1

H4

H7

H2

H3 H5 H6

H14

H12

H11

H10

H8

H13

Median

TARGET

SOARSTEMI, Non-Transfer, Primary PCI Only

% of Cases in Each time category (n=121 complete)

19

% of STEMI

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

<100; 10.6%

<200; 39.0%

<300; 16.3%<400; 5.7%

+400, 28.5%

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

20

Median

21

STEMI – Dallas County D2B OutcomesPrimary PCI, Non-Transfer Only

H1H2H3H4H5H6H7H8H9

H10H11H12H13

Most Consistently Low D2B (with least variability)

D2B Outcomes by Hospital

22

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

2 Data witheld on cases for confidentiality purposes

Hosp.

Size/Volume Range (total cases)

# STEM

I Cases

STEMI (NT,

Primary PCI)

Mean D2B

Median D2B

Std Dev

Coef of Var Min Max

H1 <50 96.0 77.0 53.3 55.5% 53 225H2 <50 64.4 62.0 16.4 25.4% 46 97H3 >50 78.1 78.5 12.2 15.6% 60 109H4 >50 64.9 65.0 13.3 20.4% 38 85H5 <50H6 >50 104.0 74.5 110.0 105.0% 32 478H7 <50 90.3 77.5 37.0 40.9% 62 144H8 <50 105.0 95.0 47.1 44.9% 58 192H9 <50 66.1 65.5 28.9 43.7% 23 120H10 >50 70.0 71.0 14.1 20.2% 42 82H11 <50 66.8 59.5 30.7 46.0% 39 116H12 <50 114.0 50.0 139.0 122.0% 34 321H13 <50 165.0 104.0 153.0 92.9% 43 494H14 >50 76.7 77.5 30.6 39.9% 34 137H15 - -

Totals 603 203 121 1 85.5 74.0 64.7 75.7% 23 494

D2B Times STEMI, Non-Transfer, Primary PCI Only

% of Cases in Each time category (n=121 complete)

23

<60 Mins61-90 Mins

91-120 Mins>2 hours

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

25.6%

53.7%

11.6%9.1%

STEMI Outcomes

24

•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%)