Process of care performance measures and long-term outcomes in patients hospitalized with heart failure.

Published

Journal Article

Recent efforts to improve care for patients hospitalized with heart failure have focused on process-based performance measures. Data supporting the link between current process measures and patient outcomes are sparse.To examine the relationship between adherence to hospital-level process measures and long-term patient-level mortality and readmission.Analysis of data from a national clinical registry linked to outcome data from the Centers for Medicare and Medicaid Services (CMS).A total of 22,750 Medicare fee-for-service beneficiaries enrolled in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure between March 2003 and December 2004.Mortality at 1 year; cardiovascular readmission at 1 year; and adherence to hospital-level process measures, including discharge instructions, assessment of left ventricular function, prescription of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge, prescription of beta-blockers at discharge, and smoking cessation counseling for eligible patients.Hospital conformity rates ranged from 52% to 86% across the 5 process measures. Unadjusted overall 1-year mortality and cardiovascular readmission rates were 33% and 40%, respectively. In covariate-adjusted analyses, the CMS composite score was not associated with 1-year mortality (hazard ratio, 1.00; 95% confidence interval, 0.98-1.03; P = 0.91) or readmission (hazard ratio, 1.01; 95% confidence interval, 0.99-1.04; P = 0.37). Current CMS process measures were not independently associated with mortality, though prescription of beta-blockers at discharge was independently associated with lower mortality (hazard ratio, 0.94; 95% confidence interval, 0.90-098; P = 0.004).Hospital process performance for heart failure as judged by current CMS measures is not associated with patient outcomes within 1 year of discharge, calling into question whether existing CMS metrics can accurately discriminate hospital quality of care for heart failure.

Full Text

Duke Authors

Cited Authors

  • Patterson, ME; Hernandez, AF; Hammill, BG; Fonarow, GC; Peterson, ED; Schulman, KA; Curtis, LH

Published Date

  • March 2010

Published In

Volume / Issue

  • 48 / 3

Start / End Page

  • 210 - 216

PubMed ID

  • 20125043

Pubmed Central ID

  • 20125043

Electronic International Standard Serial Number (EISSN)

  • 1537-1948

International Standard Serial Number (ISSN)

  • 0025-7079

Digital Object Identifier (DOI)

  • 10.1097/MLR.0b013e3181ca3eb4

Language

  • eng