Evidence-based heart failure performance measures and clinical outcomes: a systematic review.
ABSTRACT Evidence-based performance measures for heart failure are increasingly being used to stimulate quality improvement efforts.
A literature search was performed using MEDLINE, EMBASE, Cochrane Review, and a citation review. Research studies that assessed the association between the American College of Cardiology (ACC)/American Heart Association (AHA) heart failure performance measures from the inpatient setting and patient outcomes were examined. Studies were restricted to those conducted within the United States from 2001 until the present and included at least 1 of the ACC/AHA performance measures for chronic heart failure and a clinical outcome as an endpoint. Eleven original studies and 1 literature review met the study inclusion criteria. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-blocker use at discharge had the strongest association with improved patient outcomes, whereas discharge instructions had a weaker but positive effect.
The findings from this systematic review suggest that an increase in compliance with the heart failure performance measures leads to a consistent positive impact on patient outcomes although the strength, magnitude, and significance of this effect is variable across the individual performance indicators. Further longitudinal studies and additional measure sets may yield deeper insights into the causal relationship between heart failure processes of care and clinical outcomes.
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ABSTRACT: The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing. We conducted a nationwide, population-based prospective study using data from the Danish Heart Failure Registry. The registry systematically monitors and audits the use of guideline recommended processes of care at Danish hospital departments treating incident HF patients. We identified patients registered between 2003 and 2010 (n = 24504) and examined changes in use of recommended processes of care and 1-year mortality. The use of the majority of the recommended processes of care increased substantially from 2003 to 2010: echocardiography (from 62.7% to 90.5%; Relative Risk (RR) 1.45 (95% CI, 1.39-1.50)), New York Heart Association classification (from 29.4% to 85.5%; RR 2.91 (95% CI, 2.69-3.14)), betablockers (from 72.6% to 88.3%; RR 1.23 (95% CI, 1.15-1.29)), physical training (from 5.6% to 22.8%; RR 4.04 (95% CI, 2.96-4.52)), and patient education (from 49.3% to 81.4%; RR 1.65 (95% CI, 1.52-1.80)). Use of ACE/ATII inhibitors remained stable (from 92.0% to 93.2%; RR 1.01 (95% CI, 0.99-1.04)). During the same period, 1-year mortality dropped from 20.5% to 12.8% (adjusted Hazard Ratio 0.79 (95% CI, 0.65-0.96). Use of guideline recommended processes of care has improved among patients with incident HF included in the Danish Heart Failure Registry between 2003 and 2010. During the same period, a decrease in mortality was observed.BMC Health Services Research 10/2013; 13(1):391. DOI:10.1186/1472-6963-13-391 · 1.66 Impact Factor
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ABSTRACT: Introduction: Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care. Methods: We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013. Results: The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity. Conclusions: Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care.PLoS ONE 11/2014; 9(11):e112282. DOI:10.1371/journal.pone.0112282 · 3.53 Impact Factor
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ABSTRACT: OBJECTIVE The purpose of this study was to determine if institutions with inpatient cardiovascular credentialed pharmacists exhibit improved quality measures for acute myocardial infarction (AMI) and heart failure (HF) care compared with institutions without inpatient cardiovascular credentialed pharmacists. METHODS We conducted a multicenter, retrospective, cross-sectional, matched case-control study. Hospitals with at least one Added Qualification in Cardiology (AQCV) inpatient pharmacist were included in the case group. Each case group hospital was matched to hospitals without an AQCV pharmacist by region, number of cardiovascular discharges, and teaching hospital designation in a 1: 3 ratio (case: control). The 34 AQCV hospitals were matched to 102 non-AQCV hospitals. The proportions of discharges meeting HF and AMI process of care measures and 30-day outcomes (readmission and mortality) for each hospital were determined from public data and compared between the case and control groups. RESULTS Hospitals with AQCV pharmacists performed better on process of care measures than hospitals without AQCV pharmacists (odds ratio 1.41, 95% confidence interval 1.25-1.58, p<0.0001, p<0.001 for heterogeneity), which was mainly driven by the aspirin on discharge for AMI and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker on discharge for HF measures. No differences were observed between the groups for either readmission or mortality at 30 days. CONCLUSIONS Hospitals that used inpatient AQCV pharmacists performed better on process of care measures than hospitals that do not use inpatient AQCV pharmacists. However, improvements in process of care performance measures observed in AQCV hospitals did not translate into improved 30-day clinical outcomes.Pharmacotherapy 08/2014; 34(8). DOI:10.1002/phar.1444 · 2.31 Impact Factor