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Medical Care:
doi: 10.1097/MLR.0b013e3181ca3eb4
Original Article

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

Patterson, Mark E. MPH, PhD*; Hernandez, Adrian F. MD, MHS†‡; Hammill, Bradley G. MS*; Fonarow, Gregg C. MD§; Peterson, Eric D. MD, MPH†‡; Schulman, Kevin A. MD*‡; Curtis, Lesley H. PhD*‡

Supplemental Author Material
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Abstract

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.

© 2010 Lippincott Williams & Wilkins, Inc.

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