Program Questions
Data Definitions
General Information
If we are not sure if the documentation in the chart supports our choice of one of the response items, how should the abstractor answer the question?
What follows is COAP’s guidance on selecting your best response: this explicitly recognizes the importance of the abstractor’s judgment of the evidence available at time of abstraction. We strongly encourage you to answer every question.
- Select “Yes” (or select from the options provided) if in the judgment of the abstractor there is sufficient evidence in the medical record to demonstrate that the condition is present or the criteria or definitions are met.
- Select “No” if in the judgment of the abstractor there is sufficient evidence in the medical record to demonstrate that the condition has been ruled out or is not present.
- If in the judgment of the abstractor there is insufficient evidence in the medical record to answer either “Yes” or “No” or to select any of the options provided, leave the element blank. If a question cannot be or is not answered, the response will appear in the COAP database as “missing.” A high number of missing elements may have an effect on risk-adjustment and/or participation status (see “Data Collection and Submission Logistics” later in this document). There are also two questions with an option for “not measured”: Question 21 (pre-procedure stenosis) and question 37 (creatinine)
If a PCI or CABG is attempted but aborted before completion, should a form be filled out for the procedure?
As of January 1, 2004, COAP is collecting data on all PCIs, regardless of whether the procedure was completed. A form should be completed for all PCIs. If the PCI was completed, select “PCI-based intervention” for Q 1.9. If it was attempted but not completed (guidewire did not cross the lesion), select “Attempted PCI” for Q 1.9. If a CABG is aborted before the revascularization component is performed, it would be reasonable to not complete a form for it.
Demographics
What if a patient has no Social Security Number?
This field is used to uniquely identify each patient and avoid duplicate entries of procedures in the database. If there is no SSN, use a unique numeric identifier (such as a hospital ID).
A patient had a CABG or PCI during the quarter, but was still hospitalized on the day we send our data to the data manager. Should we include this case?
Submit only cases with both an admit and discharge date. If the patient is still in-house, send that case to the data manager when the patient is discharged. Contact COAP’s Program Manager for details.
What is my hospital’s site number, and does it change?
Each hospital is assigned a permanent site number from 1 to 35. If you are not sure what your number is, please contact COAP’s Program Director. Please note that random identifiers are used on the quarterly and annual reports in order to protect hospital identity, but your site number does not change and should be used on every case submitted.
Clinical Risk Factors and History
Please explain why questions such as cholesterol status or family history of CAD are not included in this section.
These tend to be risk factors for CAD. Their role in predicting procedural outcomes is not supported in the literature; in order to reduce response burden they were not included.
How do we answer Q 2 (patient’s weight) if there is a significant difference in weight between admit and the procedure?
In some circumstances the patient’s weight may change significantly after admit but before the procedure, e.g., a patient with CHF is diuresed. In those cases, record the weight closest to the procedure.
Cardiac Risk Factors
If the LVEF is measured more than once (e.g., before and during the procedure), or using more than one source (e.g., one from an echo and one from a cath report), which value should be recorded in Q 20? What if there is a difference in values depending on what source is used?
Record the value and the method closest in time to and prior to the procedure. An LVEF during the procedure itself may reflect issues related to the procedure and not the patient’s preoperative severity of illness. If there is a difference in values due to the source (e.g., echo vs. LV gram), record the worse (lower) value.
A patient has a PCI and then a second procedure (either PCI or CABG). The stenosis in some major vessel distributions was reduced following the PCI. How do we answer Q 21?
Q 21 asks for the highest degree of stenosis prior to the procedure you are abstracting to this form. Complete a form for each procedure. On the form for the first procedure, indicate the highest degree of stenosis before that procedure. On the form for the subsequent procedure, indicate the highest degree of stenosis before that procedure.
Procedure Variables
A patient has an IABP inserted after the stent placement or vessel dilation. Is Q24 Yes or No?
An IABP inserted in the procedure room before the surgery has begun or the cath has been inserted is ‘prior to initiation of the actual procedure’ and the answer is Yes. An IABP inserted after stent placement is not pre-procedure and the answer would be No.
A Patient has a stent without PCI; how would this procedure be indicated in question 29, PCI Procedure Table?
A stent without a balloon is considered a stent only.
A flow wire is passed across the lesion, and it is determined that a PCI is not required. Do we fill out a form for this procedure?
A form would not be completed for this procedure.
In counting grafts, would a skip graft count as two anastomoses?
A skip graft would count as two (or more) distal anastomoses for either arterial or venous grafts in Q 27 and Q 28.
In Q 29, if the guidewire crossing is unsuccessful, should we answer any additional questions?
Yes; even if the attempt is unsuccessful, answer the following questions if possible: % stenosis pre-procedure; was lesion treated before in the current or prior hospitalization; was lesion treated before with a drug eluting stent; was lesion treated before with brachytherapy; if lesion in a graft, indicate type of graft.
Please provide guidance on how to answer Q 30.0, 31.1, and 30.2 if patient was admitted directly from the physician’s office to the cath lab with a STEMI and had a PCI.
Q 30 asks if the procedure was performed or attempted for treatment of AMI, so you would answer Yes. Since the patient was a direct admit from the physician’s office—not through the ER—do not answer Q 30.1 or 30.2, as they are to be answered only for patients presenting to the ER with STEMI. Similarly, if an inpatient had a STEMI and was taken to the cath lab for intervention, Q 30.1 and 30.2 would not be answered. The reason for this is to capture (and report back to hospitals) only the “ER door to intervention time” cleanly and consistently.
Post-Procedure Events
What is the rationale for changing the questions about intra- and post-procedure procedures and events (Q 35, 36, and 43)?
These questions were changed to incorporate ACC and STS definitions and to differentiate ‘expected’ events from those considered to be true complications . The new definitions in Q43 allow COAP to determine total “return to OR” rate and differentiate them from events that can reasonably be considered complications of the CABG or PCI.
A patient has a fall two days post-CABG and is taken to the OR for a hip pinning. It’s not apparently related to the cardiac procedure. How should Q 43 be answered?
If the patient is taken to the OR for any reason, the response to Q 43 is Yes. In this example, none of the CABG choices (43.4, 43.5) applies, so leave blank.
A patient has a PCI and later goes to the cath lab for a second PCI. We fill out a form for each procedure. Is the answer to Q 44 Yes for both procedures or just for the first one?
“Following the procedure” refers to the procedure described in the data form. In this example, the answer to Q 44 is Yes for the first procedure and No for the second procedure.
How are ventilation hours rounded?
Round ventilation hours to the nearest whole number, using this statistical convention: odd numbers are rounded down, and even numbers are rounded up. For example, 3.6 hours would be recorded as 4 hours; 3.9 hours would be recorded as 3 hours.
A patient is extubated following CABG and then reintubated and extubated several times during the hospital stay. How many hours would be entered in Q 42?
Provide the total number of hours of intubation from the end of the procedure until discharge. If there are unusual circumstances that lead to multiple reintubations and the resulting total length of time is quite long, the hospital can conduct a record review to determine the reasons.
There are various ways of recording blood products, especially platelets. How should they be indicated in Q 45?
Platelet packs are multiples of single units. A “six-pack” of platelets would be recorded as 6 units, two six-packs as 12 units, etc. If one administration of pooled platelets is equivalent to 6 units, record it as 6 units. This would apply to platelet pheresis also. Enter “0” if no blood products are used. Do not leave it blank; this is recorded as “missing”.
