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Performance Measures for the Care of Patients With Heart Failure
PRESIDENT’S MESSAGE The Official Journal of the American Association of Heart Failure Nurses
Performance Measures for the Care of Patients With Heart Failure
P
erformance-improvement measures translate the strongest clinical evidence into practice, and indicate whether or not, or how often, a process or an outcome of care occurs. These initiatives help determine (1) whether we are doing the right things Sue Wingate RN, for patients, and (2) if our paPhD, CRNP tients are better because of these efforts. Performance measurement is an important component of an overall quality improvement program. Several sets of performance measures exist for the care of patients with heart failure. The Joint Commission on Accreditation of Healthcare Organizations published core measures for in-patient performance1 (Table I), and the American Heart Association (AHA) and American College of Cardiology (ACC), working with the Physician Consortium for Performance Improvement (PCPI), published measures for both in-patient and outpatient performance2,3 (Table II). Further, the Centers for Medicare and Medicaid Services measure 30-day mortality rates and 30-day risk-standardized readmission rates for patients with heart failure.4 Whatever your practice setting, you are likely to be involved in some aspect of performance measurement, whether collecting, analyzing, and interpreting data, or implementing and evaluating practice improvements related to the data. To that end, it is important to stay on top of the latest information
Sue Wingate RN, PhD, CRNP Sue is a nurse practitioner in the Heart Failure Treatment Program with Kaiser Permanente Mid-Atlantic States. She is an Associate Editor for The Journal of Cardiac Failure and is active in the American Heart Association, the Heart Failure Society of America, and the American College of Cardiology
HEART & LUNG VOL. 38, NO. 6
Table I Joint Commission on Accreditation of Healthcare Organizations in-patient core measures1 1. Discharge instructions 2. Left ventricular function assessment 3. Angiotensin-converting enzyme inhibitor for left ventricular systolic dysfunction 4. Adult smoking cessation advice/ counseling
Table II ACC/AHA clinical performance measures2,3 In-patient 1. Evaluation of left ventricular systolic function 2. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for left ventricular systolic dysfunction 3. Anticoagulation at discharge for heart failure patients with atrial fibrillation 4. Discharge instructions addressing activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen 5. Adult smoking cessation advice/ counseling Out-patient 1. Initial laboratory tests 2. Left ventricular systolic function assessment 3. Weight measurement 4. Blood pressure measurement Continued
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457
Table II. Continued
5. Assessment of clinical symptoms of volume overload 6. Assessment of clinical signs of volume overload 7. Assessment of activity level 8. Patient education addressing disease management and health behavior changes 9. Beta-blocker therapy for patients with left ventricular systolic dysfunction 10. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy for patients with left ventricular systolic dysfunction 11. Warfarin therapy for patients with atrial fibrillation
related to these measures. The ACC/AHA/PCPI recently developed a draft proposal for updating the 2005 measurement set. Several new measures were added, and a few measures were proposed for deletion. The measurement set was open for public
458
www.heartandlung.org
comment until September 20, 2009. I encourage all members to follow the progress of this important document, so that we can be ready to integrate it into our practice settings.
Sue Wingate, RN, PhD, CRNP President, AAHFN REFERENCES 1. Joint Commission on Accreditation of Healthcare Organizations. Available at: http://www.jointcommission.org/PerformanceMea surement/PerformanceMeasurement/Heart+Failure+Core+Mea sure+Set.htm (accessed September 17, 2009). 2. Bonow RO, Bennett S, Basey DE, Ganiats TG, Hlatky MA, Konstam MA, et al. ACC/AHA clinical performance measures for adults with chronic heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Heart Failure Clinical Performance Measures). J Am Coll Cardiol 2005;46:1144-78. 3. Physician Consortium for Performance Improvement. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/370/hfset -12-5.pdf (accessed September 17, 2009). 4. Centers for Medicare and Medicaid Services. Available at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Coun ter=3478&intNumPerPage=10&checkDate=&checkKey=&srch Type=1&numDays=3500&srchOpt=0&srchData=&keyword Type=All&chkNewsType=6&intPage=&showAll=&pYear=&year =&desc=&cboOrder=date (accessed September 17, 2009).
NOVEMBER/DECEMBER 2009
HEART & LUNG
Performance Measures for the Care of Patients With Heart Failure
P
erformance-improvement measures translate the strongest clinical evidence into practice, and indicate whether or not, or how often, a process or an outcome of care occurs. These initiatives help determine (1) whether we are doing the right things Sue Wingate RN, for patients, and (2) if our paPhD, CRNP tients are better because of these efforts. Performance measurement is an important component of an overall quality improvement program. Several sets of performance measures exist for the care of patients with heart failure. The Joint Commission on Accreditation of Healthcare Organizations published core measures for in-patient performance1 (Table I), and the American Heart Association (AHA) and American College of Cardiology (ACC), working with the Physician Consortium for Performance Improvement (PCPI), published measures for both in-patient and outpatient performance2,3 (Table II). Further, the Centers for Medicare and Medicaid Services measure 30-day mortality rates and 30-day risk-standardized readmission rates for patients with heart failure.4 Whatever your practice setting, you are likely to be involved in some aspect of performance measurement, whether collecting, analyzing, and interpreting data, or implementing and evaluating practice improvements related to the data. To that end, it is important to stay on top of the latest information
Sue Wingate RN, PhD, CRNP Sue is a nurse practitioner in the Heart Failure Treatment Program with Kaiser Permanente Mid-Atlantic States. She is an Associate Editor for The Journal of Cardiac Failure and is active in the American Heart Association, the Heart Failure Society of America, and the American College of Cardiology
HEART & LUNG VOL. 38, NO. 6
Table I Joint Commission on Accreditation of Healthcare Organizations in-patient core measures1 1. Discharge instructions 2. Left ventricular function assessment 3. Angiotensin-converting enzyme inhibitor for left ventricular systolic dysfunction 4. Adult smoking cessation advice/ counseling
Table II ACC/AHA clinical performance measures2,3 In-patient 1. Evaluation of left ventricular systolic function 2. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for left ventricular systolic dysfunction 3. Anticoagulation at discharge for heart failure patients with atrial fibrillation 4. Discharge instructions addressing activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen 5. Adult smoking cessation advice/ counseling Out-patient 1. Initial laboratory tests 2. Left ventricular systolic function assessment 3. Weight measurement 4. Blood pressure measurement Continued
www.heartandlung.org
457
Table II. Continued
5. Assessment of clinical symptoms of volume overload 6. Assessment of clinical signs of volume overload 7. Assessment of activity level 8. Patient education addressing disease management and health behavior changes 9. Beta-blocker therapy for patients with left ventricular systolic dysfunction 10. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy for patients with left ventricular systolic dysfunction 11. Warfarin therapy for patients with atrial fibrillation
related to these measures. The ACC/AHA/PCPI recently developed a draft proposal for updating the 2005 measurement set. Several new measures were added, and a few measures were proposed for deletion. The measurement set was open for public
458
www.heartandlung.org
comment until September 20, 2009. I encourage all members to follow the progress of this important document, so that we can be ready to integrate it into our practice settings.
Sue Wingate, RN, PhD, CRNP President, AAHFN REFERENCES 1. Joint Commission on Accreditation of Healthcare Organizations. Available at: http://www.jointcommission.org/PerformanceMea surement/PerformanceMeasurement/Heart+Failure+Core+Mea sure+Set.htm (accessed September 17, 2009). 2. Bonow RO, Bennett S, Basey DE, Ganiats TG, Hlatky MA, Konstam MA, et al. ACC/AHA clinical performance measures for adults with chronic heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Heart Failure Clinical Performance Measures). J Am Coll Cardiol 2005;46:1144-78. 3. Physician Consortium for Performance Improvement. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/370/hfset -12-5.pdf (accessed September 17, 2009). 4. Centers for Medicare and Medicaid Services. Available at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Coun ter=3478&intNumPerPage=10&checkDate=&checkKey=&srch Type=1&numDays=3500&srchOpt=0&srchData=&keyword Type=All&chkNewsType=6&intPage=&showAll=&pYear=&year =&desc=&cboOrder=date (accessed September 17, 2009).
NOVEMBER/DECEMBER 2009
HEART & LUNG