Heart Failure Daily Care Measures

• The relationship between core measure performance and the resource utilization and mortality of patients with heart failure has been studied (Werner RM, Bradlow ET. Relationship between Medicare's hospital compare performance measures and mortality rates. JAMA. 2006 Dec 13;296(22):2694-702.) and identifies that measuring core measures alone, may be inadequate.
• Studies from registries like the ADHERE registry point out that there are gaps in heart failure care including inadequate diuresis.
• When developing heart failure care measures, it is important to keep the following issues in mind:
  
  
• How well are inputs and outputs monitored?
• What proportion of patients are prescribed an ACEI or ARB who truly have a contraindication?
  
• How is advance care planning initiated or continued in the hospital?
• How many patients are being prescribed medications that may worsen their heart failure?
• What proportion of patients is prescribed a beta-blocker at discharge?
• How well do patients understand their diagnosis and follow-up plan?
• What are the immediate post-discharge hazards and gaps?
• These are a good starting point of issues for you to consider as you think about the care that HF patients receive.
• Examining the reasons for readmission may further target which heart failure care processes you may want to target.

Heart Failure Core Measures

• Heart Failure care is publicly reported at the www.hospitalcompare.hhs.gov website
• The measures reported there have been developed by the Joint Commission and the Centers for Medicare and Medicaid Services (CMS)
• The Measures consist of:

  Heart failure core measure 1 – Discharge instructions (inclusion of all of the following)

• Discharge medications
• Activity level
• What to do if symptoms worsen
• Follow-up appointment
• Weight monitoring

Heart failure core measure 2 – Left ventricular ejection fraction assessment

Heart failure core measure 3 – Prescription of ACEI or ARB at discharge to eligible patients (or documentation of contraindication)

Heart failure core measure 4 – Smoking cessation

For a complete description and definition of each of the heart failure core measures go to The Joint Commission’s website.

The core measures serve as important evidence-based practice measures and are also routinely collected at most hospitals, so the data collection strategies may already be in place at your institution. It is important as the improvement team leader to become familiar with these processes and with the people involved in them at your organization.

• The process for patients ending up in the heart failure core measure set of patients is very important to understand. Using a process flow map can be very helpful.
• Service-floor- and health-care-provider-specific data are helpful.
• In addition to the outcome data, any data looking at the use of specific tools that have been developed to improve performance is also helpful as it may help to identify the problem or gap resulting in the outcome core measure.