Process of care performance measures and long-term outcomes in patients hospitalized with heart failure.
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.


METHODS
Analysis of data from a national clinical registry linked to outcome data from the Centers for Medicare and Medicaid Services (CMS).


METHODS
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.


METHODS
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).


CONCLUSIONS
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.
Patterson
Mark E
ME
Center for Clinical and Genetic Economics, Duke University School of Medicine, Durham, NC, USA.
Hernandez
Adrian F
AF
Hammill
Bradley G
BG
Fonarow
Gregg C
GC
Peterson
Eric D
ED
Schulman
Kevin A
KA
Curtis
Lesley H
LH
D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D016540:Smoking Cessation; D016896:Treatment Outcome; D014481:United States
D002317:Cardiovascular Agents