Influence of a Performance-Improvement Initiative on Quality of Care for Patients Hospitalized With Heart Failure

Abstract

Background: Despite evidence-based national guidelines for optimal treatment of heart failure (HF), the quality of care remains inadequate. We sought to evaluate the effect of a national hospital-based initiative on quality of care in patients hospitalized with HF. Methods: Two hundred fifty-nine US hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) submitted data on 48 612 patients with HF from March 1, 2003, through December 31, 2004. Admission, hospital, discharge care, and outcomes data were collected using a Web-based registry that provided real-time feedback on performance measures benchmarked to other hospitals. Process-of-care improvement tools, including evidence-based best-practice algorithms and customizable admission and discharge sets, were provided. Results: Provision of complete discharge instructions and smoking-cessation counseling increased significantly (from 46.8%-66.5% and 48.2%-75.6%, respectively; P Ͻ .001 for both). Left ventricular function assessment started at a high rate (89.3%) and improved to 92.1% (P Ͻ .001). Angiotensin-converting enzyme inhibitors were prescribed at discharge to 75.8% of eligible patients, which did not improve during the 2-year study. There were trends for reduction of in-hospital mortality, postdischarge death, and combined postdischarge death and rehospitalization and a significant reduction in mean length of stay. Use of preprinted admission order sets and/or discharge checklists increased from 35.6% to 54.1% and was associated with an increase in the use of evidence-based therapies and lower risk-adjusted in-hospital mortality. Conclusions: Participation in OPTIMIZE-HF was associated with an increase in use of evidence-based therapy, adherence to performance measures, and shorter lengths of stay in patients hospitalized with HF. Increased use of process-of-care improvement tools was associated with further improvements in quality of care. Trial Registration: clinicaltrials.gov Identifier NCT00344513.

Improving Quality of Care and Outcomes for Heart Failure - Role of Registries -

“…12 Use of these clinical decision support tools and performance feedback may also eliminate the variability in care between hospitals/practices and improve the overall treatment of HF patients. 15 Performance improvement registries are designed to implement a number of clinical decision support tools to facilitate the care of HF patients at each stage of care. For example, the tools for patients hospitalized with HF address each care transition, from initial presentation and evaluation in the emergency department, admission, throughout hospital stay, discharge, and the transition to the outpatient care setting.…”

“…12 There were 259 US hospitals participating in OPTIMIZE-HF, submitting data on 48,612 HF patients during 2003-2004. 15 The characteristics of patients entered into OPTIMIZE-HF are shown in Table. With OPTIMIZE-HF, provision of complete discharge instructions and smoking-cessation counseling increased significantly (47% to 67% and 48% to 76%, respectively, P<0.0001 for both). LV function assessment started at a high rate (89%) and improved to 92% (P<0.0001).…”

Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction

“…Several precipitating clinical factors have been identified that may contribute to HF hospitalizations (2)(3)(4)(5)(6)(7). These Guidelines-HF (GWTG-HF) program is a registry and performance improvement program for patients hospitalized for HF that prospectively tracks several performance measurements and other quality of care indicators for hospitalized patients with HF (8,9).…”

Comorbid Heart Failure and Renal Impairment: Epidemiology and Management

“…The last several years have shed significant insights into the cardiorenal epidemiology with data from three large registries [8,9,10,11,12]. On the therapeutic side, outcome data are still based on observational and post hoc analyses as most randomised HF trials excluded patients with high serum creatinine (SCr) levels.…”