Purpose
History
What We Do
Outcomes
Privacy Policy and Ethics Review
Our Sponsors

Purpose

• Achieving best practices requires tools to measure and assess clinical care
• Caregivers should measure what they do and benchmark the care they provide to regional and national standards
• Macstrak provides these information tools. Created by caregivers for caregivers, these tools are suited to varied clinical environments
• Macstrak serves as a valuable tool for the analysis and refinement of cardiac care at a national level

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History

• Macstrak is an acronym for Managing the Acute Coronary Syndromes—A Tracking Project
• Designed to provide participating hospitals with a quality assurance tool
• Initiated in September 1994 in 47 Coronary Care Units in southern Ontario
• Offered to CCU’s across Canada in 1996
• Expanded to emergency departments and cardiac wards in 1998

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What we do

Data Collection

• The data tool is a simple one-page form completed for each cardiac patient admitted to the hospital unit
• The form is filled out prospectively at the bedside by the primary caregiver and is forwarded to the project office for scanning, a data quality process and entry into the data set
• Data is reported back to centres each quarter
• An admission count is forwarded to the project office to track the capture of patients in the data set
• The Project tracks admissions to Coronary Care Units but has been expanded to include cardiac presentations to Emergency Departments and Cardiology Wards
• The registry is continuously evolving to meet the changing needs and issues of the participants
• New data fields are added and standard reports are revised to reflect and anticipate new best practices
• Support for the data collection process is provided through phone, fax and e-mail contact

Data Management

• Standard reports organize data to support quality assurance projects with appropriate benchmarking based on region and hospital size
• MacsFlirt (Macstrak - Focused Longitudinal Information Retrieval Tool) is a custom software package offered to all participating sites
• MacsFlirt receives and organizes all the reports from the project office in an electronic format
• MacsFlirt includes a graphics tool to assist with analyzing and communicating the data across a centre
  

Intervention

• Each quarter, the project office identifies an issue of interest from the data and includes graphing templates focused on the issue
• These templates include centre specific data and appropriate benchmarks

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Outcomes

• The data process monitors the results of the interventions to improve care
• Hospitals have used their data to initiate programs as varied as patient education to the restructuring of treatment protocols

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Privacy Policy and Ethics Review

The medical community, Ethics Review Boards, government, and patients are supportive of data-driven quality assurance and understand the essential role it plays in achieving best practices. Review of these projects, however, is important for ensuring appropriate management of the data and safeguards for patients. The challenge is creating an appropriate level of review without creating logistical barriers that would limit the scope or impact of quality assurance. We encourage the medical community to engage in these discussions. Best practice encourages hospitals to include information available to patients on how medical information is used. A tool for patient information is available in the Resources section.

Privacy Policy

• The Macstrak Project office is responsible for all issues of data integrity and is based at the University Health Network, University of Toronto.
• No hospital specific data is disclosed to any third party without the consent of the participants.
• Unique patient identifiers are not included in the data.
• Data is held on a secure server with limited access.
• Use of the data is strictly limited to the mission of the Project - improving cardiac care for our patients. This use may include the publishing of benchmarks. On occasion there may also be research use of the data. All research projects receive separate ethics review.

Ethics Review

• Standards for ethics review of data collected for quality assurance continue to evolve. The Macstrak Project is supportive of these discussions and the role of the Ethics Review Boards. 
• It is our opinion that ethics review is appropriate and necessary for projects like Macstrak.

• Macstrak has sought and obtained review and approval from the ERB at the UHN, University of Toronto.

• This review confirms that individual patient consent is not required for collection of Macstrak data. 

• It is reasonable that a single Ethics Review Board, at the centre responsible for a project, review a project.  Separate review by each participating centre should not be required.

• If you have any questions, please feel free to contact us at the Project Office, or the Ethics Review Board, University Health Network, Toronto (416-946-4438).

  Refs

  FG Miller, EJ Emanuel NEJM Vol. 358, No. 8, 765-67 21 February 2008

  MA Baily NEJM Vol. 358, No. 8, 768-69 21 February 2008

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Macstrak Sponsors

The Macstrak Project Office is supported by unrestricted educational grants. This support allows the project to be offered to hospitals across Canada at no cost. We would like to thank the following sponsors for their generous support:

• Boehringer Ingelheim Canada Ltd.
• Hoffmann-La Roche Ltd.
• Johnson & Johnson Canada
• Medtronic of Canada
  

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