Abstract 39: Creating a Dilated Cardiomyopathy Registry to Drive Population-level Quality Improvement Projects

Abstract

Background: Since the passage of the Affordable Care Act, the health care system and medical professionals have been challenged to adopt population health strategies to deliver higher quality care to groups enrolled within a health system. Children’s National Health System (CNHS) has developed condition specific registries, which currently focus on seven condition specific population groups, one of which is dilated cardiomyopathy. Objective: To create, validate, and increase accuracy of data collected in a region-wide pediatric dilated cardiomyopathy registry to improve and deliver higher quality care and support data-driven population-level quality improvement projects across the pediatric health system. Methods: A multidisciplinary team was formed to develop measure specific inclusion and exclusion criteria based on specific ICD-10 and CPT codes. The clinical team reviewed and validated the criteria for seven clinical measures. The Business Intelligence team utilized HealtheIntent EDW (Enterprise Data Warehouse) and HealtheAnalytics to generate real-time reporting allowing clinical teams to monitor incoming patients. HealtheIntent enables real-time intelligence and data aggregation to occur directly from Cerner Millennium electronic health record. HealtheAnalytics technology then provides analytic tools to help with data visualization through time series charts and graphs reflecting improvement. Results: There are currently 113 patients with dilated cardiomyopathy tracked through the CNHS registry. For the initial measures tracked, 69% (n=78) had an outpatient cardiology visit and 32.3% (n=32) had a 24-hour Holter monitor performed in the last year as of Dec. 2018. Number of ED visits, hospitalizations, echocardiograms and flu shot compliance data is in the process of being collected. The registry was further developed to track patients by individual provider, so each cardiologist can see the specific metrics for each of their patients. Discussion: Health system registries, such as the CNHS registry, provide a unique opportunity to identify gaps in care and provide real-time, actionable data to providers with the goal of improving population health. Over the first year, there was a marked improvement in outpatient follow-up visits and 24-hour Holter monitors, however much of this can be attributed to data cleanup and mapping efforts to ensure patients met inclusion criteria and all tests were appropriately captured. It is essential for the registry to reflect accurate data in order to reduce unnecessary or duplicative visits or tests. The registry has allowed us to identify areas for quality improvement, including improved outpatient follow up and routine 24-hour Holter monitors. The next step is to engage pediatric cardiologists in using this real-time data to improve health outcomes and then using the registry to track results and initiate research studies.