National Anesthesia Clinical
The Anesthesia Quality Institute (AQI) is home to the National Anesthesia Clinical Outcomes Registry (NACOR), a data warehouse that has been designated as a Qualified Clinical Data Registry (QCDR) by the Centers for Medicare and Medicaid Services (CMS) for Physician Quality Reporting System (PQRS) reporting. With 25 million cases and growing, AQI's clinical data provides an evidence-based rationale that informs treatment choices and helps control treatment costs.
NACOR is intended for all anesthesia providers, in all practice settings. The registry provides participating providers with:
Custom continuous performance monitors
Performance gap analysis and patient outlier identification
Access to improvement interventions to close performance gaps including patient care management tools, targeted education, and links to anesthesia information technology vendors.
Participants have continuous online access to NACOR reports regarding their practice. Reports allow participants to identify gaps in specific quality measures and focus efforts to close those gaps. Performance tracking reports capture trends over time and help measure improvements in quality care. NACOR also provides participants with access to national benchmarking reports.
NACOR participants can also improve care by reviewing performance results across their patient population. This information helps to address clinical gaps in a timely manner. Consider and choose interventions that can lead to sustainable practice improvement for your aggregate performance, which can help reduce the number of outliers in the future.
NACOR identifies possible interventions for improvement based on clinical quality gaps found through calculating selected data. Data can be used to review performance and determine quickly the impact of an improvement intervention. Results are presented graphically to identify trends in performance.
The first anesthesia QCDR
NACOR is approved by CMS as a Qualified Clinical Data Registry (QCDR). A QCDR is a registry which includes approved PQRS and non-PQRS measures used for federal Pay for Performance programs. Previously, physician anesthesiologists have had a limited number of PQRS measures to report on, making it difficult to meet emerging standards for avoiding penalties and earning incentives. NACOR has more than 25 additional anesthesia-related-measures approved enabling eligible professionals (EPs) to satisfactorily report on outcomes that matter to them and their patients, and more easily meet PQRS and Value Modifier requirements.
QCDR reporting services are included in ASA membership, and all EPs may participate through ASA membership. Non-member physicians and non-physicians must pay additional fees. All eligible professionals using QCDR reporting services must be participating in NACOR.
Steps for becoming a NACOR participant
NACOR participants range from pen-and-paper anesthesiology practices to the most wired academic centers. You do not need an AIMS system or electronic health record (EHR) to participate. AQI will help facilitate the contribution of desired data.
NACOR allows for close collaboration between AQI, individual providers and healthcare technology vendors. Roles are defined as follows:
AQI Key Roles
Define data and outcomes collected in NACOR
Provide unifying definitions and templates
Contract with individual practices and hospitals to exchange data
Report collected data
Individual Anesthesia Practices, Hospitals and Providers Key Roles
Provide data to NACOR
Use reports to improve patient care to meet various local, state and federal regulatory requirements
Vendors of Anesthesia Information Technology Key Roles
Facilitate NACOR through reporting work with individuals; vendors that provide formatted data for contribution to NACOR will be listed as AQI Preferred Vendors
View a detailed description of the desired data for NACOR
AQI's Data Auditing and Validation
NACOR's data validation routines come in two forms. One set determines the correctness of incoming data prior to insertion. The other set verifies the integrity of all NACOR cases. This overlap validation creates a tight net that ensures all NACOR case data is accurate.
AQI has 3 validation stages for data:
Pre-stage validation: NACOR's incoming data currently comes from over 100 different sources. Data validation at this level is source specific. The validation is concerned with the structure and format of the data.
Pre-Production Validation: This stage of validation is an automated process for case level data integrity checks prior to NACOR insertion.
Post-insert Auditing: All records int he registry undergo continual auditing on a daily basis.
NACOR is a relational database with strong referential integrity to ensure the consistency of anesthesia data. This means that every record in NACOR contains values that are well defined (reference values) and commonly reported from any anesthesia information technology system. All case data are subject to intense scrutiny upon entry into NACOR. This is supplemented with a continual, more focused authentication process that lasts the entire lifetime of the data within the registry. With a two-tiered validation method, NACOR retains its accuracy while maintaining its ability to absorb large amounts of information at low cost.
NACOR Data Validation and Auditing Checkpoints
Data Validity Checks Automated in NACOR