Metrics and measures in NCDR reports provide information on hospital performance compared with aggregate benchmarks of all registry participants to guide internal quality improvement efforts. NCDR follows the American College of Cardiology Foundation (ACC)/American Heart Association (AHA) classifications:
Performance Measures are those process, structure, efficiency, or outcome measures that have been developed using American College of Cardiology (ACC)/American Heart Association (AHA) methodology, including the process of public comment and peer review and have been specifically designated as performance measures by the ACC/AHA Task Force on Performance Measures.
Quality Metrics are those measures that have been developed to support self-assessment and quality improvement at the provider, hospital, and/or healthcare system level.
The above classifications of metrics and measures have been defined by the ACC/AHA Task Force on Performance Measures.
Performance measures, endorsed by the ACC/AHA Task Force on Performance Measures and the National Quality Forum (NQF) are appropriate for consideration for additional quality programs, including public reporting and recognition programs by third parties.
Metrics and measures are developed with expert guidance using clinical guidelines (including guidelines developed by the ACCF with collaboration from other specialty societies) and evidence. In developing metrics and measures, the NCDR uses the leading methodology to identify and test metrics and measures that are scientifically valid and meaningful to hospitals for benchmarking for quality improvement. This includes, when appropriate, the development of composite metrics and risk-adjusted outcome metrics that can provide more usable information about quality of care than unadjusted individual metrics.
NCDR Risk-Adjusted and Composite Measures and Metrics:
PCI In-Hospital Mortality
• All PCI Patients
• STEMI Patients
• NSTEMI Patients
Acute Kidney Injury
PCI 30-Day Readmission
Death, emergency CABG, stroke or repeat target vessel, revascularization
Therapy with aspirin, P2Y12 inhibitor, and statin at discharge following PCI in eligible
AMI In-Hospital Mortality
Overall Defect Free Care
ICD in-hospital risk adjusted complications
Therapy with ACE/ARB and beta blocker at discharge following ICD implantation in eligible patients
Reported separately for CAS and CEA Patients:
- Risk adjusted rate of Stroke or Mortality (RASM)
Risk models will be included in the PVI report after four quarters of data are collected.
Reported separately for CAS and CEA Patients:
Reported for patients undergoing Lower Extremity interventions:
- Incidence of stroke or death for symptomatic patients
- Incidence of stroke or death for asymptomatic patients
- Incidence of stroke, death, or MI for symptomatic patients
- Incidence of stroke, death, or MI for asymptomatic patients
- Incidence of Major Adverse Event
- Incidence of Bleeding
PCI=Percutaneous Coronary Intervention, ICD=Implantable Cardioverter Defibrillator, AMI=Acute Myocardial Infarction, CAS=Carotid Artery Stenting, CEA=Carotid Artery Endarterectomy, STEMI=ST Elevated MI, NSTEMI=Non-ST Elevated MI.
A composite performance measure is the combination of 2 or more indicators into a single number to summarize multiple dimensions of provider performance and to facilitate comparisons. For more information about composite measures in the NCDR, please click here.
Risk-adjusted outcomes account for variations in a hospital’s patient population to provide a fair comparison of outcomes reported in the registry. A hospital’s case mix reflects differences in patient risk factors prior to the procedure and these differences often affect outcomes. Risk adjustment “levels the playing field” among participating institutions by taking into account the predicted outcomes of their patient populations prior to the procedure. For more information about risk-adjustment in the NCDR, please click here.
More information about NCDR measures and metrics is available to participants when they log in and go to the “Resources” section for each registry, including detailed information on specifications for metrics, along with the rationale and guidelines/evidence supporting each metric.
The National Quality Forum (NQF) endorses national consensus standards for measuring and publicly reporting on performance. Several measures that are reported in the NCDR have received NQF endorsement, indicating they are appropriate for consideration for public reporting and other accountability programs. The following NCDR measures have received NQF Endorsement
- ACE/ARB Therapy at Discharge for ICD implant patients with LVSD
- Beta Blocker at Discharge for ICD implant patients with a previous MIBeta Blocker at Discharge for ICD implant patients with LVSD
- Composite: Therapy with ACE/ARB and beta blocker at discharge following ICD implantation in eligible patients
For more information about the National Quality Forum and the endorsed measures reported in NCDR, please go to www.qualityforum.org.