CED Data Sources (Text Version)

Slide Presentation from the AHRQ 2010 Annual Conference

On September 29, 2010, James Rollins made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (590 KB). Free PowerPoint® Viewer (Plugin Software Help).

Slide 1

CED Data Sources
AHRQ Annual Conference

September 2010

James A Rollins, MD, MSHA, PhD
Coverage and Analysis Group
Office of Clinical Standards and Quality
Centers for Medicare & Medicaid Services

Slide 2

Current CED Data Sources

• ICD Registry
  Created by the American College of Cardiology Foundation
• NOPR
  National Oncologic PET Registry

Slide 3

ICD Registry and Variables Collected

• Demographic information:
  • Name
  • SSN
  • Patient ID
  • Date of Birth
  • Race
  • Ethnicity
  • Gender

Slide 4

History of Risk Factors

• History of Heart Failure
• Duration of Symptoms
• Prior hospitalization for HFM, Timeframe
• NYHA Functional Classification
• Prior Heart Transplant
• Non-Ischemic Dilated Cardiomyopathy Timeframe
• Syncope, Family Hx of Sudden Death

Slide 5

History and Risk Factors (cont.)

• On Transplant Waiting List
• Atrial Fibrillation/Flutter
• Ventricular Tachycardia (Hemodynamic instability)
• Cardiac Arrest
• Syndrome w/Risk of sudden death
• Previous ICD (date, implant site, reason, primary or secondary prevention

Slide 6

History and Risk Factors (cont.)

• Ischemic Heart Disease
• Prior MI
• Prior PCI
• Prior CABG

Slide 7

Diagnostic Studies

• LVEF Assessed
• Electrophysiologic Study (study timeframe, ventricular arrhythmias induced, VT ablation performed, EP study findings)
• Lead ECG w/Automated Measurements
• PR interval
• QRS duration

Slide 8

Diagnostic Studies

• Cardiac Rhythms
• Abnormal Intraventricular Conduction

Slide 9

ICD Implant/Explant

• ICD Indication

Slide 10

NOPR Registry and Variables Collected

• Demographics:
  • Name
  • SSN
  • Patient's 5 Digit Zip Code
  • Date of birth
  • Race
  • Ethnicity
  • Gender
  • Date of Procedure
  • PET Facility ID#

Slide 11

Specific Reason for PET Study

• Restaging
• Suspected Recurrence
• Monitoring Treatment Response:
  • During chemotherapy
  • During radiation therapy
  • During combined modality therapy
• Diagnosis (Leukemia only)
• Diagnosis/Paraneoplastic (Leukemia only)
• Initial Staging (Leukemia only)

Slide 12

Cancer Type (ICD-9 Code)

• Stomach (151)
• Small Intestine (152)
• Anus (154)
• Liver and intrahepatic bile ducts (155)
• Gall bladder & extrahepatic bile duct (156)
• Pancreas (157)
• Retroperitoneum and peritoneum (158)
• Lung, small cell (162)
• Pleura (163)
• Thymus, heart, mediastinum (164)
• Kaposi sarcoma (176)
• Uterus, unspecified (179)
• Uterus, body (182)
• Prostate (185)
• Testis (186)
• Penis and male genitalia (187)
• Bladder (188)
• Kidney and other urinary tract (189)
• Eye (190)
• Primary Brain (191)
• Leukemia (204-208)
• Neuroendocrine tumor (209)
• Metastatic cancer unknown  (203)

Slide 13

Cancer Type

• Has this cancer diagnosis been pathologically proven?
• Unknown primaries: Dominant site of pathologically proven or strongly suggested metastatic disease
  e.g., Lymph node, lung, liver, brain, bone, other

Slide 14

Stage Before PET Scan

• No evidence of disease
• Localized only
• Regional by direct extension or lymph node
• Distant metastasis with single suspect site
• Distant metastasis with multiple susp. sites
• Unknown or uncertain

Slide 15

Patient Performance Status

• Asymptomatic, fully active
• Symptomatic, fully ambulatory
• Symptomatic in bed <50% of the day
• Symptomatic in bed >50% of the day
• Bedridden, completely disabled

Slide 16

Monitoring Treatment Responses

• Is the current ongoing treatment intended to be
  • Curative or palliative?

Slide 17

Management Plans

• If PET were not available, what management strategy would be used?
  • Observation (with close follow up)
  • Additional Imaging (CT, MRI, other NIT)
  • Tissue Biopsy (surgical, percutaneous, endoscopic
  • Treatment

Slide 18

Management Plan (cont.)

• Treatment Goals:
  • Curative
  • Palliative
• Types of Treatment:
  • Surgical
  • Chemotherapy
  • Radiation
  • Supportive Care
• Will treatment be directly provided by you?

Slide 19

CED Data Sources

• The Web site for the source to Medicare data is http://www.resdac.umn.edu/