Blog | Tuesday, April 24, 2012

QD: News Every Day--9 performance measures for heart failure expand use of beta-blockers to inpatient care, among other recommendations

Updates to heart failure performance measures include an expanded use for beta blockers and new quality metrics for internal quality improvement, reports the American College of Cardiology Foundation.

The latest measures expand the use of beta-blockers to the inpatient setting. Included only as an outpatient measure in the 2005 set, this measure was added for the inpatient setting after inpatient care guidelines were developed in the 2009 guidelines update.

Clinical trial data showing that not all beta-blockers exhibit the same benefits prompted the writing committee to specify the use of one of three evidence-based beta-blockers: bisoprolol, carvedilol or sustained-release metoprolol, the report states.

Another significant change in the 2011 performance measures set was the conversion of the measure on patient education to a quality metric, which should be used for internal quality improvement purposes only, not public reporting and accountability. While the writing committee acknowledged that patient education about lifestyle, activity, diet and medication use is important for providing optimal care, they also understood that compliance with an education measure is easy to achieve without regard to the quality of education provided.

Other changes to the 2011 performance measures include the combination of both the inpatient and outpatient settings in a measure about the use of ACE inhibitors or ARB therapy for left ventricular systolic dysfunction; the addition of a new measure on the post-discharge appointment at the time of hospital discharge; and the retirement of measures on weight measurement, blood pressure measurement, and warfarin therapy for patients with atrial fibrillation. These measures were retired either because they had been included as part of a broader measure in a different set or they had become standards of care.

Other quality metrics include one on counseling about implantable cardioverter-defibrillators and another on symptom management. The 2011 performance measures include care provided in both the outpatient and inpatient setting, emphasizing the need to measure care quality over time and across providers, while also focusing on patient outcomes.

"In order to improve the quality of heart failure care, one has to provide measures of quality. The heart failure performance measures were designed for that purpose--to allow physicians and their care teams to deliver evidence-based management designed to improve heart failure outcomes without disrupting the workflow," said writing committee co-chair Robert O. Bonow, MD, MACP, of the Northwestern University Feinberg School of Medicine.

The nine 2011 performance measures include three new measures and six revised ones. Two measures apply to care provided in both the inpatient and the outpatient settings, while five measures address outpatient care only and two measures address inpatient care only. Eight measures from the previous heart failure performance measures set, which were released in 2005, were retired.

While six of the measures are appropriate for initiatives such as pay for performance, physician ranking and public reporting, three of them are intended only for internal quality improvement purposes.

According to the performance measures writing committee, consistent use of the set is key to the measures' adoption. "To be successful as quality improvement tools, the heart failure performance measures need to be integrated as routine components of patient care across various care settings, with particular attention to transitions of care from inpatient to outpatient environments," Dr. Bonow said.