• Mark E Patterson, Adrian F Hernandez, Bradley G Hammill, Gregg C Fonarow, Eric D Peterson, Kevin A Schulman, and Lesley H Curtis.
• Center for Clinical and Genetic Economics, Duke University School of Medicine, Durham, NC, USA.
• Med Care. 2010 Mar 1; 48 (3): 210-6.

BackgroundRecent 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.ObjectiveTo examine the relationship between adherence to hospital-level process measures and long-term patient-level mortality and readmission.Research DesignAnalysis of data from a national clinical registry linked to outcome data from the Centers for Medicare and Medicaid Services (CMS).SubjectsA 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.MeasuresMortality 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.ResultsHospital 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).ConclusionHospital 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.

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