Process of Care Performance Measures and Long-Term Outcomes in Patients Hospitalized With Heart Failure

Bibliographic Data

ID9104898
AuthorsMark E Patterson (0000-0002-2600-6887, corresponding author), Adrian F Hernandez (0000-0003-3387-9616, Duke University), Bradley G Hammill (0000-0002-0389-6434, Clinical Research Institute, corresponding author), Gregg C Fonarow (0000-0002-3192-8093, University of California, Los Angeles), Eric D Peterson (0000-0002-5415-4721, Duke University), Kevin A Schulman (0000-0002-8926-5085, Clinical Research Institute, corresponding author), Lesley H Curtis (0000-0002-3286-9371, Duke University, corresponding author)
Year2010
Volume48
Issue3
Pages210-216
Publication date2010-03-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3181ca3eb4
PMID20125043
PMCIDPMC3723387
OpenAlexW2092254223
LanguageEN
Citations received5
References cited18

BACKGROUND: 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. OBJECTIVE: To examine the relationship between adherence to hospital-level process measures and long-term patient-level mortality and readmission. RESEARCH DESIGN: Analysis of data from a national clinical registry linked to outcome data from the Centers for Medicare and Medicaid Services (CMS). SUBJECTS: 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. MEASURES: 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. RESULTS: 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). CONCLUSION: 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

Confidence interval · Hazard ratio · Health care · Heart failure · Medicaid · Medical prescription · Acute Myocardial Infarction Research · Diabetes Treatment and Management · Emergency Medicine · Heart Failure Treatment and Management · Internal Medicine · Medicine

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