Operator:
It is now my pleasure to turn today's program over to Lori Hollowell, national senior program manager for Mission: Lifeline and Get With The Guidelines-CAD. Ms. Hollowell, the floor is yours.
Lori Hollowell:
Thank you. And on behalf of the American Heart Association, American Stroke Association, and Mission: Lifeline, we welcome all of you to today's webinar, Get With TheGuidelines-CAD and Mission: Lifeline. The Path and Future are Now. On today's webinar, we have the pleasure to hear from three of our national clinical volunteer experts in addition to AHA staff. Each of today's speakers will provide information on the changes to Mission: Lifeline and to Get With The Guidelines-CAD programs. It is my pleasure to introduce our presenters for today. First is Dr. Gregg Fonarow. He is the Eliot Corday Professor of Cardiovascular Medicine and Science at UCLA. He serves as director of theAhmanson-UCLA Cardiomyopathy Center, co-director of UCLA's Preventive Cardiology Program, and clinical co-chief of cardiology, UCLA Division of Cardiology. He has attained the rank of professor of medicine, Geffen School of Medicine at UCLA in 2003. Dr. Fonarow is the chair of the Get With The Guidelines QI Subcommittee and is a national member of the Get With The Guidelines Heart Failure Clinical Work Group. And then Dr. Harper Stone. He is a cardiologist at the Jackson Heart Clinic in Jackson, Mississippi. He is also the chair of the Mission: Lifeline Steering Committee and the immediate past chair of the Mission: Lifeline ACS subcommittee. Dr. Stone is also a board member for the American Heart Association's Greater Southeast affiliate and is president of the Mississippi Healthcare Alliance. Then we have Dr. Tim Henry. Tim Henry is the director, Division of Cardiology and the chair in research cardiology at Cedars-Sinai Heart Institute in Los Angeles, California. He is also the chair of the Mission: Lifeline subcommittee. Then we have also have Christine Rutan. Christine is the American Heart Association’s national director for Quality and Health Information Technology.
At this time, I would like to turn it over to Dr. Henry so he can give some introductory remarks. Dr. Henry?
Tim Henry, MD:
Hi, everyone. I'm delighted to be here this morning. And I apologize, I have a little bit -- with the short timing of the webinarI am giving a grand rounds in Beaumont and so I have a little conflict but I'd like to really start off and sort of give a little background and history for Mission: Lifeline, and then as the current ACS chairman, which is basically STEMI system from a Mission: Lifeline standpoint, give you sort of my perspective on where we're going.
So number one, I think it's really important to remember that the goal of why Mission: Lifeline was really originated, and what our purpose is, and that is to improve STEMI systems of care in the United States. You know, I'm fond of saying, you know, we'll only be successful when every hospital in America has a well-designed standardized system and is able to measure those outcomes. And I think that's really ultimately should be our goal. And I was part of the design at the original conference, which I chaired, way back in 2006, and on the initial Mission: LifelineAdvisory Committee so I've been really involved for over the last ten-plus years, and developed our own STEMI system in the State of Minnesota, really back since the beginning of 2000. So I'm passionate about this. And I think as everybody knows, there's been this partnership with the ACC that it used action, Get With The Guidelines. For complex reasons, that's changing now, but I think what I want to assure you is that I think that the Mission: Lifeline structure, and in particular the team, the staff that works in state-to-state Mission: Lifeline is really essential to accomplishing this mission of improving STEMI care in the United States. So I'm going to turn it over to Gregg and Harper to sort of talk about the CAD Get With The Guidelines strengths and weaknesses. But the last thing that I would say is that I will tell you that from my standpoint, from my committee, and from my belief, the leadership from the American Heart Association, we're committed to not only take the current tool, but to continue to make that tool better, and with input from really clinicians and scientists around the United States to get what I think, and this is an opportunity for us to get to the point where we have a STEMI database that is user-friendly and able to really connect with 90-plus percent of hospitals around the country. And that should be our goal, that we have a user-friendly database that allows us to get real-time feedback. And I think that this has the opportunity, and certainly I'll give you from my perspective, I'm committed to making that happen. So I apologize I have to leave, but Gregg and Harper will walk through more of the details, and I think then there will be a good time for questions, and a lot of time over the next few months, there will be a lot of time to sort of discuss these options and see how this in particular this project grows. So thank you for allowing me to be on, and thank you, Lori.
Christine Rutan:
Thank you, Dr. Henry, for those remarks. This is Christine Rutan from the American Heart Association, and before I turn the call over to both Dr. Fonarow and Dr. Stone, I did want to take a moment to review some of the frequently asked questions that we've received since launching -- since announcing that they were launching Get With The Guidelines-CAD, and we certainly want to answer all the questions that you submit on today's webinar, but we know that these are most likely the ones that are top of mind, so we wanted to make sure that we went through these five in particular just to make sure that you had answers to those. So one of the first questions that we've received is: who supports Mission: Lifeline? And Mission: Lifeline is a program owned and operated by the American Heart Association, and it's exclusively supported by its more than 100 professional quality improvement field staff nationwide. And we are so proud of the work that we've done since Mission: Lifeline launched in 2007, and we're really committed to continuing to work to improve systems of care across the country. Get With The Guidelines-CAD, in keeping with that vein, was recently relaunched by the AHA to continue to engage hospitals and EMS providers in this work.
Many of you have asked: How do I continue to participate in Mission: Lifeline? And it's important for you to know that there is no longer a mechanism for AHA to obtain your data directly from the action registry for the purposes of Mission: Lifeline reporting, as well as to facilitate our field staff consultation. And the way to ensure participation in Mission: Lifeline and to continue to obtain the recognition and benefits is to enroll directly with the American Heart Association by signing a unified participation agreement and a business associate agreement. And both of those are available online, and you can receive copies, as well, from your AHA field staff, or you can e-mail with additional questions about those. But these agreements really allow us to collect, store and analyze your data within Get With The Guidelines-CAD for the purposes of Mission: Lifeline.
We've also received a number of questions about how your data would be collected for Mission: Lifeline. We also wanted to add some clarifying points around that. Currently Get With The Guidelines-CAD is the primary source for Mission: Lifeline data, and it's the means by which AHA is able to continue to provide Mission: Lifeline reports and our field staff are able to continue to engage with you in data analysis and process improvement activities. Hospitals can enter data in a number of ways. They can directly -- enter directly via the streamline form that we're offering. They can upload data via the CSV uploader, which can accept data from any alternate source. It will be available in June 2017, and really its function is for hospitals who wish to export data from other sources such as an EMR, an alternate registry, or other source, and format that data appropriately that it can be uploaded for Get With The Guidelines-CAD record population. And AHA staff and Quintiles IMS are prepared to support hospitals through this process. Over the course of the next year, we intend to make data upload even more seamless. We’re looking to expand capabilities to accept additional file types, so in addition to CSV, as well as different submission methods. So we are working on expanding those capabilities, but right now, both Quintiles IMS and AHA field staff are at the ready to support you through this process. And I should note that sites can upload retrospective data. We've also received that question as well. So if you do want to take your historic data and upload that, we are happy to help you through that process.
The next question we've received quite frequently is whether or not Get With The Guidelines-CAD will support chest pain accreditation data submission. And, as many of you know, the American Heart Association and the American College of Cardiology are proud partners in cardiac accreditation, and I did include a link to where you can find out additional details about this partnership. But clinical data registries, while each organization will continue to operate separately and offer those clinical data registries separately, one of the primary goals of this partnership was really to ease the burden of data entry for sites and to meet sites where they are. And for that goal, both organizations have made a commitment to support the data needs and requirements for hospitals participating in any of the joint ACC/AHA accreditation offerings. So it's really incumbent on us now to Get With The Guidelines-CAD has been launched that we build out those data elements and measures necessary for chest pain accreditation. And if you look at the case report form that we've initially launched with, we do capture many of the data elements needed for chest pain accreditation, and we will have some of those measures in June once our measures are released. But we're working diligently to fully support all of the 23 required measures by winter of 2017.
And the final question that we've received is: what is the cost For Get With The Guidelines? And you wanted to know 2017 pricing, as well as what we project 2018 pricing to be. And right now in 2017, Get With The Guidelines-CAD is being offered for free. We want to encourage participation, and we don't want any sites to experience barriers, so we're happy to offer the tool for free this year. We're still working to establish 2018 pricing. We expect that we'll be able to announce in June what the price point will be, but we're advising hospitals for budgeting purposes our commitment really is that the amount would not exceed what you've historically paid for action registry Get With The Guidelines.
That concludes the frequently asked questions. So I'm actually going to turn the call over to Dr. Fonarow at this point to walk us through the Get With The Guidelines-CAD and Mission: Lifeline evolution. But again, I wanted to encourage you, if you have additional questions, please type them in and we'll do our best to get to all of them either during the webinar or in follow-up with you afterwards. So Dr. Fonarow, I'll turn it over to you now.
Gregg Fonarow, MD:
Sure. Thanks so much. And thank you all for joining us to hear about the next iteration and generation in improvement for systems of care, quality, and outcomes for patients with acute myocardial infarction. I just wanted to give you a little additional background of the evolution in this space. So in fact, it was the American Heart Association, back in 2001, that launched the first comprehensive registry around acute myocardial infarction patients, Get With The Guidelines-CAD. There were 600 to 800 hospitals participating, and really powered initial improvements in quality of care and outcomes towards this important patient population. With the launch of Mission: Lifeline in 2007, there was a vision about Get With The Guidelines-CADtogether with the Action Registry that was then launched with the transition, and by 2010, Get With The Guidelines-CAD sites were participating through the Action Registry Get With The Guidelines that was supported by the NCDR platform. In 2007, with Mission: Lifeline having launched, there was the opportunity for the Mission: Lifeline reports that came online in 2011, and hospital recognition offered in 2010, and EMS recognition being newly offered in 2014. However, there's now the great opportunity moving forward with the re-launch of Get With The Guidelines-CAD that was first announced April 7th to really now participate in the transformation to next generation quality improvement. This is going to make the Mission: Lifeline reports far more responsive and docile to the data that's being collected, really enhance the linkage across additional data sources. So we'll have additional data collection and reporting options going forward. So really the AHA and all that are working on Mission: Lifeline systems of care are really delighted to have this valuable tool brought back so the real-time data reporting, coupled with tremendous support of the AHA field staff and all that are working in the communities to improve STEMI systems of care will have the action quality data that they need to really make meaningful improvements in care and outcome.
The next slide actually shows us just one of more than 50 publications in the peer reviewed literature that define the impact that Get With The Guidelines-CADhas had on improving quality of care. Outcomes even before the launch of Mission: Lifeline, we were seeing substantial improvement for acute care for patients arriving with STEMI and non-STEMI. In fact, during the door to balloon time alliance, Get With The Guidelines-CAD participating at hospitals, even if not in the door to balloon time alliance, had substantial improvements in their timeliness of STEMI care that matched those that were participating. This is an analysis shown of looking at improvements over time in hospitals participating in Get With The Guidelines-CAD versus those that were not and showing higher levels of performance and greater improvements over time. Again, demonstrating that the power of the patient management tool in Get With The Guidelines-CAD and the field staff and national recognition to all come together to make meaningful improvements in processes of care and ultimately outcomes for this patient group. So this is just to highlight what a robust platform this is. Certainly there's been further evolution over time with Get With The Guidelines-Heart Failure, Get With The Guidelines-Stroke, Get With The Guidelines-CAD-Atrial Fibrillation and Resuscitation, and all of those learnings and skills and advancements of the patient management tool are being iterated and integrated into Get With The Guidelines-CAD relaunch. So couldn't be happier to have this opportunity to bring this really powerful platform together with Mission: Lifeline as we move forward. So, now let me turn it over to Dr. Stone.
Harper Stone, MD:
Good morning, everybody. I appreciate y'all allowing me to talk to you this morning. And I've got some really important stuff to talk to you about. First, I want to talk about the core components of Mission: Lifeline. You know, the foundation of Mission: Lifeline program is its AHA quality staff, its volunteers, and its participating hospitals and EMS agencies. Building upon that foundation is the data. The data actually drives quality improvement in hospitals with EMS agencies and, more importantly, is the basis for coordinated regional approach to care. As the Mission: Lifeline STEMI system matures, the regional and state levels see marked improvements in their processes, which leads to a decrease in the total ischemic time and improved outcomes for STEMI patients, which all this supports AHA's 2020 goal of reducing death and disability for all Americans by 20% and improving the health of all Americans. You can go to the next slide.
And let's talk about some accomplishments of Mission: Lifeline. Well, since 2010, Mission: Lifeline has impacted STEMI care on many fronts and this is a few highlights todate. If you look at the map, as of January 2015, the blue indicates a self-reported STEMI systems of care registered with Mission: Lifeline. At the time the associated questionnaire was returned, 85% of the United States was covered by Mission: Lifeline STEMI systems of care, which is unbelievable. There are 988 hospitals participating in Mission: Lifeline and receiving Mission: Lifeline reports, and are eligible for Mission: Lifeline recognition data analysis. There are 92 regions across the U.S. receiving Mission: Lifeline regional reports, which are used to regionalize STEMI systems of care. In those 92 regions, there's 847 hospitals participating in these regions. There's also over 600EMS agencies participating in the recognition program, which is great. EMS has really bought into these systems of care. And through our good work, our EMS first medical contact and device time has decreased from 2010 up to 2016, from 88 down to 79 minutes. We've increased the achievement of EMS first medical contact to PCI from 56% of the time to 72.8% of the time. And really, the great thing about EMS is our 12-lead EKG pre-hospital has increased from 52% up to 79%. And that just bodes and tells the story of what the system of care that Mission: Lifeline has led when we have EMS, volunteers, hospitals, all working together through a good system that has shortened the length of time for treatment of these patients.