The impact of patient-specific quality-of-care report cards on guideline adherence in heart failure.
BACKGROUND
It is unknown if physician education through heart failure (HF) patient-specific quality-of-care report cards (HFRC) impacts outpatient HF guideline adherence.


METHODS
A prospective pre-post design study was performed to test the hypothesis that a one-time, patient-specific HFRC delivered to physicians after HF patient (ejection fraction < or = 40%) discharge would lead to improved HF guideline adherence compared with control practitioners. Patients were contacted at 1, 3, and 6 months after discharge to assess medication usage and intolerances. Six month quality score (QS) was the primary end point, calculated as the sum of adherence to 4 medication performance measures (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, aldosterone inhibitors, and warfarin for atrial fibrillation).


RESULTS
The mean QS at discharge was 3.10 +/- 0.78 in controls (n = 189) and 3.25 +/- 0.79 in the HFRC group (n = 76, P = .11). Controlling for discharge QS, the HFRC resulted in a significantly improved QS at 3 months (beta = .11, P = .023) but not at the 6-month primary end point (beta = .084, P = .14). Controlling for baseline medication use, patients of practitioners receiving the HFRC were 32.5 (P = .019) and 8.5 (P = .030) times more likely to receive, or have a documented contraindication to, an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker at 3 and 6 months, respectively. There were no significant differences in indicated beta-blocker, aldosterone inhibitor, or warfarin prescriptions at any follow-up.


CONCLUSIONS
Although one-time patient-specific report cards result in short-term statistically significant improvements in outpatient evidence-based HF care, the gain does not translate into sustained improvements in quality of care.
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
Jennifer Cowger
JC
Matthews
Monica L
ML
Johnson
Todd M
TM
Koelling
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002309:Cardiology / Q000592:standards*; D017723:Drug Utilization Review; D005194:Family Practice / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D014859:Warfarin / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D014859:Warfarin