Hospital Compliance With Performance Measures in Heart Failure
Background In 2005, the American College of Cardiology/American Heart Association published performance measures to provide a standard of care for hospitalized patients with heart failure (HF). Despite increasing compliance with these measures, hospital mortality and readmission rates remain stagnant. Whether compliance with HF performance measures improves patient outcomes at the hospital level is unclear.
Methods We evaluated compliance with HF performance measures at 3,655 US hospitals. Patients admitted with a diagnosis of HF in 2008 were identified using the US Department of Health and Human Services Hospital Compare database. Compliance with 4 specific performance measures was examined: evaluation of left ventricular systolic function, administration of angiotensin-converting enzyme inhibitor I or angiotensin-receptor blocker for left ventricular systolic dysfunction, offering smoking cessation advice and counseling, and providing discharge instructions. Thirty-day mortality and readmission rate were recorded.
Results Hospitals reporting greater compliance with the 4 performance measures had significantly lower 30-day mortality rates. However, these hospitals were also located in areas of higher socioeconomic status and treated higher volumes of patients with HF. After adjusting for socioeconomic and hospital factors, only evaluation of left ventricular systolic function was associated with lower 30-day mortality, and evaluation of left ventricular systolic function and smoking cessation counseling were associated with lower readmission rates.
Conclusions We found that socioeconomic factors and hospital volume were stronger predictors of mortality than compliance with HF performance measures. After adjusting for socioeconomic factors and hospital volume, only 1 of the 4 performance measures was associated with lower 30-day mortality and 2 were associated with lower readmissions.
In the United States, the prevalence of heart failure (HF) is approximately 5.7 million individuals including 670,000 new cases in adults 45 years or older in 2008. Although survival after diagnosis is improving, the mortality rate at 5 years remains high. One in every 9 deaths has HF mentioned on the death certificate. The impact on the medical system is tremendous, with 990,000 HF-related hospital discharges and more than 3.4 million ambulatory visits for HF in 2007. The estimated direct and indirect cost of HF in the United States in 2010 was $34.4 billion.
In 2005, the American College of Cardiology and American Heart Association (AHA) published clinical performance measures for HF, including specific recommendations for hospitalized patients, which were intended to provide both a mechanism for quality improvement and a method to measure quality of care. Over the past decade, hospitals have been steadily increasing compliance with these process measures. However, HF mortality rates have not declined and have remained stagnant. Whether compliance with performance measures improves patient outcomes at the hospital level is unclear.
It is important to understand the differences in the treatment of HF provided by hospitals nationwide to identify gaps in care and highlight specific factors that are associated with quality care. This study examined more recent data regarding compliance with HF performance measures and the association with 30-day mortality and readmission rates as well as the relationship with socioeconomic and hospital-specific factors.
Abstract and Introduction
Abstract
Background In 2005, the American College of Cardiology/American Heart Association published performance measures to provide a standard of care for hospitalized patients with heart failure (HF). Despite increasing compliance with these measures, hospital mortality and readmission rates remain stagnant. Whether compliance with HF performance measures improves patient outcomes at the hospital level is unclear.
Methods We evaluated compliance with HF performance measures at 3,655 US hospitals. Patients admitted with a diagnosis of HF in 2008 were identified using the US Department of Health and Human Services Hospital Compare database. Compliance with 4 specific performance measures was examined: evaluation of left ventricular systolic function, administration of angiotensin-converting enzyme inhibitor I or angiotensin-receptor blocker for left ventricular systolic dysfunction, offering smoking cessation advice and counseling, and providing discharge instructions. Thirty-day mortality and readmission rate were recorded.
Results Hospitals reporting greater compliance with the 4 performance measures had significantly lower 30-day mortality rates. However, these hospitals were also located in areas of higher socioeconomic status and treated higher volumes of patients with HF. After adjusting for socioeconomic and hospital factors, only evaluation of left ventricular systolic function was associated with lower 30-day mortality, and evaluation of left ventricular systolic function and smoking cessation counseling were associated with lower readmission rates.
Conclusions We found that socioeconomic factors and hospital volume were stronger predictors of mortality than compliance with HF performance measures. After adjusting for socioeconomic factors and hospital volume, only 1 of the 4 performance measures was associated with lower 30-day mortality and 2 were associated with lower readmissions.
Introduction
In the United States, the prevalence of heart failure (HF) is approximately 5.7 million individuals including 670,000 new cases in adults 45 years or older in 2008. Although survival after diagnosis is improving, the mortality rate at 5 years remains high. One in every 9 deaths has HF mentioned on the death certificate. The impact on the medical system is tremendous, with 990,000 HF-related hospital discharges and more than 3.4 million ambulatory visits for HF in 2007. The estimated direct and indirect cost of HF in the United States in 2010 was $34.4 billion.
In 2005, the American College of Cardiology and American Heart Association (AHA) published clinical performance measures for HF, including specific recommendations for hospitalized patients, which were intended to provide both a mechanism for quality improvement and a method to measure quality of care. Over the past decade, hospitals have been steadily increasing compliance with these process measures. However, HF mortality rates have not declined and have remained stagnant. Whether compliance with performance measures improves patient outcomes at the hospital level is unclear.
It is important to understand the differences in the treatment of HF provided by hospitals nationwide to identify gaps in care and highlight specific factors that are associated with quality care. This study examined more recent data regarding compliance with HF performance measures and the association with 30-day mortality and readmission rates as well as the relationship with socioeconomic and hospital-specific factors.