Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study finds limitations in publicly reported quality-of-care indicators for heart-failure patients

05.01.2007
Beta-blocker measure superior to all existing indicators

Academic researchers reported that all five standard hospital-based performance measures used to gauge quality of care for hospitalized heart failure patients may not be the best benchmarks since none were significant predictors of patient mortality during the critical first 60 to 90 days immediately following hospital discharge.

Published in the Jan. 3 issue of the Journal of the American Medical Association, the study found that none of the current measures used by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) which accredits hospitals and by the Federal Government through the Center for Medicare and Medicaid Services (CMS) to assess hospital performance were associated with a lower risk of mortality during the days immediately following hospital discharge when adverse events are most likely to occur.

Only one of the standard measures modestly influenced mortality and rehospitalization rates. Researchers also reported that use of beta blocker medications in eligible heart failure patients at time of hospital discharge, currently not a JCAHO/CMS performance measure, was associated with the most significant improvements in heart failure patient outcomes – predictive of a 52 percent reduction in mortality during the first 60 to 90 day period after hospital discharge.

Professional societies, health care accrediting organizations, the government, and major insurers use performance measures to rank and accredit hospitals, rate quality of care, and develop hospital as well as physician pay-for- performance initiatives. According to researchers, performance measures should reflect the strongest clinical evidence in practice and failure to perform these key treatments should reduce the likelihood of optimal patient outcomes.

"The study's findings are quite surprising since it has been commonly held that existing performance measures could be used to distinguish hospitals that provide higher quality heart failure care and that these indicators were strongly linked to clinical outcomes." said Dr. Gregg C. Fonarow, The Eliot Corday Chair in Cardiovascular Medicine and Science, principal investigator and director, Ahmanson-UCLA Cardiomyopathy Center.

Fonarow added that the findings do not lessen the importance of providing recommended elements of heart failure care covered by the existing performance measures nor does it preclude these measures from influencing patient quality-of-life or long-term survival.

However, Fonarow noted that the study does demonstrate that the factors influencing mortality and rehospitalization after discharge for heart failure may be driven by a different set of care processes and better methods for identifying and validating new performance measures are needed.

Researchers utilized data on 5,791 patients seen at 91 hospitals, taken from a large heart failure patient registry and performance improvement program called the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).

Researchers statistically analyzed the relationship between the five standard performance measures and clinical outcomes within the 60 to 90 days after patient discharge. Four of these heart failure measures are currently used by JCAHO/CMS and are publicly reported on the Hospital Compare website: http://www.hospitalcompare.hhs.gov.

The five measures, developed by the American College of Cardiology and the American Heart Association, included: 1) Giving complete medical instructions to patients upon hospital discharge; 2) Evaluation of the heart's left ventricle systolic function; 3) Prescribing patients an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blockers (ARB) drugs; 4) Smoking cessation counseling and 5) Prescribing anticoagulation for atrial fibrillation.

Researchers also evaluated prescribing of a beta-blocker at hospital discharge, another key medication for heart failure that currently is not assessed with a performance measure.

The study determined that none of the five standard measures were significantly associated with reduced early mortality risk and only ACE inhibitor or ARB use modestly affected mortality or rehospitalization outcomes. Prescribing a beta-blocker in eligible patients, however, was strongly associated with lower mortality risk and lower death/rehospitalization risk.

"This study has identified and validated a new performance measure that could be used to augment existing measures and more effectively quantify the quality of care provided to heart failure patients in the hospital setting" said Fonarow. "If this beta-blocker measure was adopted by JCAHO/CMS and the levels of performance achieved by OPTIMIZE-HF hospitals in providing beta blockers were achieved by hospitals nationwide, we estimate that an additional 19,000 lives a year could be saved."

The investigators noted that while performance measures for heart attack have a strong association with mortality outcomes, the connection for heart failure measures have not been as well studied.

"While the current performance measures for heart failure have some rationale for their continued use, in determining which measures should be publicly reported and used for pay-for- performance programs, there should be better selection of measures that significantly influence patient outcomes early after hospital discharge." said Fonarow, Professor of Medicine, UCLA Division of Cardiology.

Fonarow added that it may be helpful to require hospitals to report actual patient outcomes such as mortality or mortality/rehospitalization rates in the first 30-90 days post-discharge to help track and identify which hospitals are providing better care. Currently hospitals only report in-hospital process of care data.

Only the American Heart Association's Get With The Guidelines – Heart Failure program, one of the national quality improvement programs for heart failure, routinely collects and reports on a beta-blocker performance measure for patients hospitalized with heart failure.

Heart failure is the leading cause of hospitalization in those over age 65 -- almost 3.6 million hospitalizations are attributed to heart failure as the primary or a secondary discharge diagnosis each year. The estimated direct and indirect costs of heart failure in 2006 are expected to be $29.6 billion. Heart failure occurs when the heart cannot pump enough blood to the body's other organs. The heart keeps working but not as efficiently as it should. This condition is caused by narrowed arteries, heart attack, high blood pressure, heart defects, infection or disease of the heart muscle or valves.

Rachel Champeau | EurekAlert!
Further information:
http://www.mednet.ucla.edu

More articles from Studies and Analyses:

nachricht Obstructing the ‘inner eye’
07.07.2017 | Friedrich-Schiller-Universität Jena

nachricht Drone vs. truck deliveries: Which create less carbon pollution?
31.05.2017 | University of Washington

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Manipulating Electron Spins Without Loss of Information

Physicists have developed a new technique that uses electrical voltages to control the electron spin on a chip. The newly-developed method provides protection from spin decay, meaning that the contained information can be maintained and transmitted over comparatively large distances, as has been demonstrated by a team from the University of Basel’s Department of Physics and the Swiss Nanoscience Institute. The results have been published in Physical Review X.

For several years, researchers have been trying to use the spin of an electron to store and transmit information. The spin of each electron is always coupled...

Im Focus: The proton precisely weighted

What is the mass of a proton? Scientists from Germany and Japan successfully did an important step towards the most exact knowledge of this fundamental constant. By means of precision measurements on a single proton, they could improve the precision by a factor of three and also correct the existing value.

To determine the mass of a single proton still more accurate – a group of physicists led by Klaus Blaum and Sven Sturm of the Max Planck Institute for Nuclear...

Im Focus: On the way to a biological alternative

A bacterial enzyme enables reactions that open up alternatives to key industrial chemical processes

The research team of Prof. Dr. Oliver Einsle at the University of Freiburg's Institute of Biochemistry has long been exploring the functioning of nitrogenase....

Im Focus: The 1 trillion tonne iceberg

Larsen C Ice Shelf rift finally breaks through

A one trillion tonne iceberg - one of the biggest ever recorded -- has calved away from the Larsen C Ice Shelf in Antarctica, after a rift in the ice,...

Im Focus: Laser-cooled ions contribute to better understanding of friction

Physics supports biology: Researchers from PTB have developed a model system to investigate friction phenomena with atomic precision

Friction: what you want from car brakes, otherwise rather a nuisance. In any case, it is useful to know as precisely as possible how friction phenomena arise –...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Closing the Sustainability Circle: Protection of Food with Biobased Materials

21.07.2017 | Event News

»We are bringing Additive Manufacturing to SMEs«

19.07.2017 | Event News

The technology with a feel for feelings

12.07.2017 | Event News

 
Latest News

NASA looks to solar eclipse to help understand Earth's energy system

21.07.2017 | Earth Sciences

Stanford researchers develop a new type of soft, growing robot

21.07.2017 | Power and Electrical Engineering

Vortex photons from electrons in circular motion

21.07.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>