Clinical InvestigationIncremental Survival Benefit With Adherence to Standardized Heart Failure Core Measures: A Performance Evaluation Study of 2958 Patients
Section snippets
Study Population and Selection
The study was conducted using data generated within Intermountain Healthcare (IHC), which serves patients in Utah, Idaho, Nevada, and Wyoming. IHC is a nonprofit, integrated health care system that includes 20 hospitals, a system of health plans, and both employed (∼400 mainly primary care) and affiliated (∼2500 mainly specialty) physicians. It is also an approved Joint Commission Performance Measurement System vendor for JCAHO core measure sets. This allowed us to link case-level information
Results
A population of 2958 patients with HF were identified for the study, with an average patient age of 73.5 ± 13.8 years and men composing 50.4% of the sample (Table 1). Smokers made up only 9.9% (n = 294) of the population, and 87.1% (2576) of patients were cared for in urban settings. Of our study population, 2.7% (n = 81) were eligible for only one HF core measure, 23% (n = 689) were eligible for two HF core measures, 66% (n = 1943) were eligible for three HF core measures, and 8.3% (n = 245)
Discussion
HF is widely recognized as a common, disabling, deadly, and costly disorder. More emphasis than ever is now being placed on optimizing care of patients with HF. The Institute of Medicine's report, Crossing the Quality Chasm, supports the national trend toward improving the quality of health care.13 Further, updated American College of Cardiology/American Heart Association and Heart Failure Society of America HF Management Guidelines recognize the importance of reducing HF morbidity and
Conclusions
This study shows that in patients hospitalized with HF, adherence to JCAHO HF core measures was associated with improved 1-year survival after discharge. It also demonstrates an association between these care processes and outcomes. Different performance assessments suggested that the HF core measures are weighted unequally, and that partial adherence to them was associated with partial survival benefit in an incremental fashion. These results underscore the importance of implementing these
Acknowledgments
The authors thank Jerod M. Loeb, PhD, Stephen P. Schmaltz, PhD, and Scott C. Williams, PsyD for valuable critique of the article and helpful suggestions on the data analysis. The authors also thank Ashley R. Renlund for technical and editorial assistance.
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