Quality Improvement for Institutions

NCDR Issues Guidance For Use of Its Clinical Cardiovascular Quality of Care Measures During COVID-19 Pandemic

The mission of the NCDR is to improve patient care and heart health through trusted, real-world evidence. The clinical benchmark reporting provided to hospitals and clinicians is based on a well-established data system and evidence-based, validated measures of quality of care and outcomes.

The global COVID-19 pandemic has disrupted health care delivery. NCDR data confirm that nationally and locally the volume of admissions and procedures (elective and nonelective) declined substantially earlier this year. These declines are likely multifactorial, including hospitals suspending elective procedures and patients delaying or deferring medical care. In addition, efforts to ensure patient and provider safety during the pandemic may result in treatment delays.

NCDR benchmark reporting is updated quarterly and reflects the previous four quarters ("rolling four quarters"). The NCDR benchmark reports provided to participating hospitals, facilities and clinicians will continue to provide valuable insights on the delivery of cardiovascular patient care for internal quality improvement efforts even during the pandemic. However, recognizing the changes required because of the pandemic, the NCDR is providing the following guidance for the use of NCDR data for the purposes of external accountability, such as health insurance payer programs or employment compensation programs.

Patient Outcomes Measures. The NCDR recommends that use of outcomes measures benchmarks, such as mortality, bleeding and stroke, should be suspended for all types of accountability programs. This recommendation is particularly true for the NCDR risk models used to account for differences in hospital case mix, e.g., comparing a hospital that treats more critically ill patients with a hospital that treats more relatively stable or healthy patients. These measures were developed based on a typical case mix of patients before the COVID-19 pandemic. The reporting is sensitive to both volume and case mix. In addition, data specific to COVID-19 as a comorbidity to patient outcomes are not currently available in the NCDR registries, so it cannot be considered as a risk factor for adverse outcomes at this time.

Care Process Measures. The evidence underlying process of care measures has not changed despite the pandemic. For example, it remains important to provide timely reperfusion for acute STEMI or to discharge patients on appropriate pharmacotherapy following hospitalization. The NCDR thus recommends that process measures remain valid for the purposes of accountability programs; however, sponsors of these programs should consider mechanisms to acknowledge disruptions to routine cardiovascular care delivery due to the COVID-19 pandemic.

The NCDR emphasizes two key points in issuing this guidance. One, the NCDR is confident that the cardiovascular clinical care being provided to patients at participating hospitals and facilities generally continues to remain of high-quality and performed in safe environments despite the COVID-19 pandemic. Two, this guidance is specific to NCDR measures. It is not intended to apply to all cardiovascular measures of quality of patient care and outcomes, either those developed by the ACC or other organizations. The use of any quality measure for accountability during the COVID-19 pandemic should be evaluated first as to its necessity to patient care, and then against the data system upon which it is calculated.

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