Quality of heart failure care in managed Medicare and Medicaid patients in North Carolina.
Use of angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic receptor blockers in patients with heart failure (HF) remains low despite the results of clinical trials and evidence-based guidelines that support their use. The quality of HF care in managed Medicare and Medicaid programs in North Carolina participating in a HF quality improvement program was assessed. Managed care plans identified adult patients with 1 inpatient or 3 outpatient claims for HF during 2000. A stratified random sample of 971 Medicare and 642 Medicaid patients' outpatient medical records from 5 plans were reviewed by trained nurse abstractors to obtain data regarding type of HF, demographics, comorbidities, and therapies. Left ventricular function assessment was performed in 88% of patients. Among 494 patients with systolic dysfunction, 86% were appropriately treated with respect to ACE inhibitors (73% prescribed, 13% had a documented contraindication). In contrast, beta-blocker therapy was appropriate in 61% (49% prescribed, 12% contraindication). There were no significant differences in drug use by insurance, gender, race, or age. Ventricular function assessment and ACE inhibitor prescription rates are higher than beta-blocker prescription rates among Medicare and Medicaid managed care patients in North Carolina. Opportunities for improvement remain, particularly for beta-blocker use.
Bertoni
Alain G
AG
Department of Public Health Sciences, Winston-Salem, North Carolina, USA.
Duren-Winfield
Vanessa
V
Ambrosius
Walter T
WT
McArdle
Jill
J
Sueta
Carla A
CA
Massing
Mark W
MW
Peacock
Sharon
S
Davis
Jennifer
J
Croft
Janet B
JB
Goff
David C
DC
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008484:Medicaid / Q000592:standards*; D008499:Medical Records; D006278:Medicare / Q000592:standards*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D017749:Total Quality Management
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors