A model for statewide compliance
In 2004, the Centers for Disease Control and Prevention (CDC) collaborated with Emory University and The American Heart Association to develop a nationwide registry that would provide an understanding of the scope and nature of the 300,000 annual out-of-hospital cardiac arrests (OHCA) in this country. The goal is for EMS providers and hospitals to provide data on OHCA in order to identify key information about the third leading cause of death in the U.S. and make changes to improve outcomes.
Data provided will allow for benchmarking at a county, state and national level. Recently, CARES expanded the program internationally with the Pan-Asian Resuscitation Outcome Study.
As of 2011, CARES has 40 participating communities in 25 states.
Thanks to a grant from the Medtronic HeartRescue Foundation, Washington was able to launch a statewide effort to register all EMS agencies and receiving hospitals into the Washington CARES program. Randi Phelps, who coordinates the program, assists EMS agencies in completing the CARES enrollment form, trains a local contact at each agency to administer the program, establishes contacts at receiving hospitals and monitors data collection.
Since starting her position at the first of the year, approximately a quarter of the state has been enrolled in the program. “The goal is to have the whole state using CARES,” Phelps says. The benefit to the statewide community will be huge. “That’s what interested me in the program,” she says.
Participation in CARES is free. “The cost is the effort of participation,” Phelps says. “But it will pay off in the end.” Even if a community is not ready to enroll in CARES, she encourages them to start collecting data using free templates.
Training time is minimal. There are 45 questions for the EMS agencies to complete. Many are optional. The data can be entered manually, completed in paper format and then optically scanned or extracted from electronic patient care reports (ePCRs,), which auto-populates the CARES registry. Optional times can be provided by computer-aided dispatch (CAD). Because some systems don’t have a relationship with CAD, Phelps suggests the registry might provide a good opportunity to create that relationship.
She tries to minimize the data entry burden by customizing dropdown menus to show only receiving hospitals in the area and local EMS agencies. CARES is also working with vendors of ePCRs to add fields. The end result is that Phelps often hears from EMS agencies and hospitals that this is the easiest registry they’ve ever used.
The hospital has just 10 questions to answer per patient. Five are optional. When they log in, they see a list of the patients who have been brought to the hospital, regardless of the agency. All but one of the questions can be answered by billing. The single exception is the Cerebral Performance Category (CPC) code. “That’s what sets CARES apart. It includes CPC,” Phelps says.
For the most part, medical directors are aware of the registry and support it. Phelps says her challenge is to find the administration or quality improvement person at each agency who will be the contact.
The carrot is the reports. A favorite is the àœtstein Survival Report, available at the click of a button.
As soon as data is entered, the program can generate reports. These can be compared to other communities, counties or the rest of the state or the nation. “Everything is so different state to state–even county to county,” Phelps says. “Unless you measure what you are doing, you can’t compare.”
The reports can be especially helpful for smaller communities. However, she notes, it does take some time to get enough data to provide meaningful statistics.
Some agencies have used the reports to leverage requests to hire a part-time quality improvement person or launch a CPR program. “You have the local data to show the need,” she says. “It’s an easy way to get the ball rolling.”
For additional reports, such as all OHCA cases that didn’t get citizen CPR, a search function can selec any of the variables. Data can be exported to Microsoft Excel or other statistical software to provide more advanced statistical analysis.
Another selling point is the follow-up report from the hospital. Many EMS agencies can see the outcomes of the OHCA patients they treat and transport to the hospital for the first time.
All data is owned locally. “We won’t report locally without permission,” Phelps says. CARES registry data is typically reported as an aggregate for the state. County data is “owned” by the respective medical directors.
The WACARES registry added a couple of questions, primarily to meet the HeartRescue Foundation requirements. They include the use of mechanical and automated CPR devices.
Phelps is pleased with the response she has received so far. “Everyone says it’s a good idea. It just needs to get done,” she says.