CHF Team Quality Report
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Heart failure is the most common reason for hospitalization among those over 65 years old, and the most expensive diagnosis for Medicare. A hospital implemented several initiatives to improve care for heart failure patients based on evidence-based guidelines and quality measures. This resulted in improved processes of care, increased adherence to quality measures, stabilization of readmission rates, and recognition as a community leader in heart failure care.
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Principles of Healthcare
Reimbursement
Student Workbook
Chapter 6
Medicare-Medicaid Prospective
Payment Systems for Inpatients
2
Activities
Theory into Practice and Real-World Case
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records from all the claims for hospital discharges of Medicare beneficiaries. The
MedPAR file contains several gigabytes of data per year. Rather than being an inert
archive, these data can be used to improve the quality of care for Medicare beneficiaries
(Ash et al. 2003; Stringham and Young 2005).
The MedPAR file is an administrative database. The data include many
administrative fields, such as diagnosis and procedure codes, claim costs and charges,
the diagnosis-related group (DRG) and—as of fiscal year 2008—MS-DRGs, and the
length of stay. However, as an administrative database, it has limitations to its
usefulness as a means of assessing the quality of patient care. The database does not
include some clinical risk factors, such as the results of diagnostic tests. The number of
other diagnoses used to record complications and comorbidities is restricted to eight.
The benefits of using the database, though, far outweigh the limitations. Cost is minimal.
The database already exists. No forms or procedures need to be created. No data
collectors need to be hired nor trained. Data collection occurs in the usual course of
business. Finally, though, research has found that the MedPAR file can be used to assess
the quality of patient care for both Medicare patients and other-payer patients
(Needleman et al. 2003).
Ash and colleagues used MedPAR claims data to predict mortality in patients
who had suffered acute myocardial infarction (AMI). They studied the years 1995
through 1999 with more than 300,000 cases per year (305,468; 308,997; 306,224; 304,882;
306,175; totaling 1,531,746). The validation data showed up to 80 percent mortality one
year post-AMI for cases in the highest risk group. Moreover, the authors found that,
prior to the AMI in the study, the patients had had a previous AMI, diabetes, or
congestive heart failure. This information about health status at admission is important
for the care of patients and for the improvement of care outcomes (Ash et al. 2003).
Stringham and Young used the MedPAR file to examine rates of urinary tract
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comorbidity (CC). The relative weight of the DRG with the CC is higher than the relative
weight for the DRG without the CC.
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2. Describe the nervous control of inspiration and respiratory rhythm
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4. Describe the influences of the Pneumotaxic and Apneustic centers
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Endocrine Therapy
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Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
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Gastrointestinal Infections
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These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
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CHF Team Quality Report
- 8. 30-day Readmit rate n=359 n=369 n=326 n=258 n=262 n=232 n=88 St. Anthony Central Snapshot (SAC Decision Support) Nat ’ l Avg: 24%
- 9. Composite Score (SAC ) (CMS/GWTG) Comprehensive HF Instructions LV Function Documented ACE/ARB @ DC for LVF <40% Smoking Cessation Advice BB @ DC for LVF <40%
- 10. HF Coordinator Hired Med-Rec tackled GWTG Data (5-measure composite)
- 12. Composite Score (SAC ) (CMS/GWTG) Comprehensive HF Instructions LV Function Documented ACE/ARB @ DC for LVF <40% Smoking Cessation Advice BB @ DC for LVF <40%
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Editor's Notes
- Our multidisciplinary team met monthly for a few years. Currently the leadership of the team (Cardiology, hospitalist and ED physicians, CV Director, and HF coordinator) meet monthly, with the entire team gathering quarterly. Essential to our success has been the active participation of physician champions and unit-based nursing champions
- Ross JS, Chen J, Lin ZQ, et al. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail 2009; available at: http://circheartfailure.ahajournals.org
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