CED Data Sources (Text Version)

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

---

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/