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Part I: Monday, November 14, 2011 © Copyright, The Joint Commission Advanced Certification in Heart Failure Measures Pilot Test Training Objectives 2 © Copyright, The Joint Commission Discuss the measure specifications, related data elements, and algorithms Review the data collection tool Provide opportunity for questions © Copyright, The Joint Commission Advanced Certification in Heart Failure Structure DSC Standards + ACHF Standards Process Outcome GWTG (B-S-G) HF Core + ACHF Measures © Copyright, The Joint Commission ACHF Quality & Safety of Care for Patients Standardized Measure Identification Process Existing evidence-based measures submitted by public/stakeholders Develop measure specifications & data collection tools Expert Advisory Panel review of submitted measures & recommendation of candidate measures Identify measure scope and framework (domains of care) Public/Stakeholder Comment re. candidate measures Expert Advisory Panel meets ( identify additional domains, endorse framework, identify extant measures) Expert Advisory Panel review of comment & final recommendation of measures Pilot test and reliability test of measures Expert Advisory Panel review of pilot results & measure revision Implementation of measure set Additional measures solicited via 30 day public comment period & via list serves, etc. Responsible entity: TJC Staff Expert Panel Public/Stakeholders © Copyright, The Joint Commission Determine measurement topic Timeline in Months TAP reviews comments and recommendations Technical Advisory Panel (TAP) Meets TAP reviews pilot results and finalizes measures Measure specifications and data collection tool developed Public Comment 6-month Pilot Test May Jun 2011 Aug Sep Oct Nov Dec Jan Feb Mar Apr Jul 2012 © Copyright, The Joint Commission Mar ACHF Initial Patient Population Two sub-populations: 7 © Copyright, The Joint Commission 1) ACHF Inpatient 2) ACHF Hospital Outpatient (Appendix A, Table 2.1 and Table 2.2) ACHF Initial Inpatient Population – ICD-9-CM Principal Diagnosis Code – ICD-9-CM Principal Procedure Code – ICD-9-CM Other Procedure Codes – Admission Date – Birthdate – Discharge Date 8 © Copyright, The Joint Commission The population of the ACHF inpatient measures is identified using 6 data elements: ACHF Initial Inpatient Population – – – – ICD-9-CM Principal Diagnosis Code for HF No ICD-9-CM Principal or Other Procedure Code of Left Ventricular Assistive Device (LVAD) or Heart Transplant Patient Age (Admission Date minus Birthdate) greater than or equal to 18 years Length of Stay (Discharge Date minus Admission Date) less than / = to 120 days 9 © Copyright, The Joint Commission Patients admitted to the hospital for inpatient acute care: ACHF Initial Inpatient Population HF Initial Patient Population Algorithm Variable Key: Patient Age Initial Patient Population Reject Case Flag Length of Stay ICD Start Start HF Initial Patient Population logic sub-routine Process all cases that have successfully reached the point in the Transmission Data Processing Flow: Clinical which calls this Initial Patient Population Algorithm. Do not process cases that have been rejected before this point in the Transmission Data Processing Flow: Clinical. ICD-9-CM Principal Diagnosis Code Not on Table 2.1 On Table 2.1 At least one on Table 2.2 ICD-9-CM Principal or Other Procedure Codes All Missing or None on Table 2.2 Patient Age (in years)=Admission Date – Birthdate Use the month and day portion of admission date and birthdate to yield the most accurate age. < 18 years Patient Age >= 18 years Length of Stay (in days) = Discharge Date minus Admission Date Length of Stay <= 120 days Patient not in the HF Initial Patient Population Patient is in the HF Initial Patient Population Patient is not eligible to be sampled for the HF measure set Patient is eligible to be sampled* for the HF measure set Set Initial Patient Population Reject Case Flag = “Yes” Set Initial Patient Population Reject Case Flag = “No” Return to Transmission Data Processing Flow: Clinical (Data Transmission section) ICD End © Copyright, The Joint Commission > 120 days Patients who had a left ventricular assist device (LVAD) or heart transplant procedure (ICD-9-CM Procedure Code for LVAD or heart transplant as defined in Appendix A, Table 2.2) Age <18 years 11 © Copyright, The Joint Commission Excluded Populations – ALL ACHF Inpatient Measures Inpatient Discharges > 120 days Patients with Comfort Measures Only documented Patients discharged to another hospital Patients who expired Patients discharged to home for hospice care Patients discharged to a healthcare facility for hospice care 12 © Copyright, The Joint Commission Excluded Populations – ALL ACHF Inpatient Measures ACHF Initial Outpatient Population – E/M Code – Discharge Status – Outpatient Encounter Date – Birthdate – ICD-9-CM Principal Diagnosis Code – ICD-9-CM Principal Procedure Code – ICD-9-CM Other Procedure Codes 13 © Copyright, The Joint Commission The population of the ACHF hospital outpatient measures is identified using 7 data elements: ACHF Initial Outpatient Population – – – – – E/M code on OP Table 1.0 Discharge Status anything not = 20 Patient Age (Outpatient Encounter Date minus Birthdate) greater than or equal to 18 years ICD-9-CM Principal Diagnosis Code for HF No ICD-9-CM Principal or Other Procedure Code of Left Ventricular Assistive Device (LVAD) or Heart Transplant 14 © Copyright, The Joint Commission Patients seen in the clinic/hospital for outpatient care: © Copyright, The Joint Commission ACHF Initial Outpatient Population Patients who had a left ventricular assist device (LVAD) or heart transplant procedure (ICD-9-CM Procedure Code for LVAD or heart transplant as defined in Appendix A, Table 2.2) Age <18 years All Discharge Status codes except 20 16 © Copyright, The Joint Commission Excluded Populations – ALL ACHF Outpatient Measures Monthly Sample Size Average Monthly Initial Patient Population Size “N” 102 131 - 505 20% of Initial Patient Population size 26 - 130 26 < 26 No sampling; 100% Initial Patient Population required 17 © Copyright, The Joint Commission 506 Minimum Required Sample Size “n” Monthly Sample Size – Example: 30 inpatient discharges and 52 outpatient visits for the month of November. Randomly select 26 inpatient records plus 26 outpatient records for review. The same patient record may be in both samples. 18 © Copyright, The Joint Commission Same methodology for both inpatients and outpatients © Copyright, The Joint Commission Inpatient and Outpatient Settings ACHF-01 Beta-Blocker Therapy (i.e., Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate) for LVSD Prescribed at Discharge Numerator: Patients prescribed bisoprolol, carvedilol, or sustained-release metoprolol succinate at hospital discharge 20 © Copyright, The Joint Commission Denominator: Heart failure patients with current or prior documentation of left ventricular ejection fraction (LVSD) < 40% ACHF-01 Included Populations Discharges with ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and 21 © Copyright, The Joint Commission Documentation of LVSD < 40% ACHF-01 Excluded Populations 22 © Copyright, The Joint Commission Patients enrolled in Clinical Trial Patients who left against medical advice Patients with a documented Reason for No Bisoprolol, Carvedilol, or SustainedRelease Metoprolol Succinate Prescribed for LVSD at Discharge ACHF-01 Data Elements 23 © Copyright, The Joint Commission Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date Discharge Disposition Denominator: ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code LVSD < 40% Reason for No Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate Prescribed for LVSD at Discharge 24 © Copyright, The Joint Commission ACHF-01 Data Elements 25 © Copyright, The Joint Commission ACHF-01 Algorithm Highlights ACHF-01a Hospital Outpatient Beta-Blocker Therapy (i.e., Bisoprolol, Carvedilol, or SustainedRelease Metoprolol Succinate) Prescribed for LVSD Numerator: Patients prescribed bisoprolol, carvedilol, or sustained-release metoprolol succinate for LVSD when seen in the outpatient setting 26 © Copyright, The Joint Commission Denominator: Heart failure patients with current or prior documentation of left ventricular ejection fraction (LVSD) < 40% ACHF-01a Included Populations 27 © Copyright, The Joint Commission E/M Code for hospital outpatient encounter as defined in OP Appendix A, OP Table 1.0, and An ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1 Documentation of LVSD < 40% ACHF-01a Excluded Populations 28 © Copyright, The Joint Commission Patients enrolled in Clinical Trial Patients with a documented Reason for No Bisoprolol, Carvedilol, or SustainedRelease Metoprolol Succinate Prescribed for LVSD in the Outpatient Setting Denominator: Birthdate Clinical Trial Discharge Status E/M Code ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code 29 © Copyright, The Joint Commission ACHF-01a Data Elements ACHF-01a Data Elements 30 © Copyright, The Joint Commission Denominator: LVSD < 40% Outpatient Encounter Date Reason for No Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate prescribed for LVSD in the Outpatient Setting ACHF-01a Data Elements 31 © Copyright, The Joint Commission Numerator: Bisoprolol, Carvedilol, or Sustained-Release Metoprolol Succinate Prescribed for LVSD in the Outpatient Setting 32 © Copyright, The Joint Commission ACHF-01a Algorithm Highlights ACHF-01b Hospital Outpatient ACEI or ARB Prescribed for LVSD Numerator: Patients who are prescribed an ACEI or ARB for LVSD when seen in the outpatient setting 33 © Copyright, The Joint Commission Denominator: Heart failure patients with current or prior documentation of left ventricular ejection fraction (LVSD) < 40% ACHF-01b Included Populations 34 © Copyright, The Joint Commission E/M Code for hospital outpatient encounter as defined in OP Appendix A, OP Table 1.0, and An ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1 Documentation of LVSD < 40% ACHF-01b Excluded Populations 35 © Copyright, The Joint Commission Patients enrolled in Clinical Trial Patients with a documented Reason for No ACEI or ARB Prescribed for LVSD in the Outpatient Setting Denominator: Birthdate Clinical Trial Discharge Status E/M Code ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code 36 © Copyright, The Joint Commission ACHF-01b Data Elements ACHF-01b Data Elements 37 © Copyright, The Joint Commission Denominator: LVSD < 40% Outpatient Encounter Date Reason for No ACEI or ARB Prescribed for LVSD in the Outpatient Setting ACHF-01b Data Elements 38 © Copyright, The Joint Commission Numerator: ACEI or ARB Prescribed for LVSD in the Outpatient Setting 39 © Copyright, The Joint Commission ACHF-01b Algorithm Highlights ACHF-01c Hospital Outpatient Aldosterone Receptor Antagonists Prescribed for LVSD Numerator: Patients who are prescribed an aldosterone receptor antagonist (spironolactone or eplerenone) for LVSD when seen in the outpatient setting 40 © Copyright, The Joint Commission Denominator: Heart failure patients with current or prior documentation of left ventricular ejection fraction (LVSD) < 40% ACHF-01c Included Populations 41 © Copyright, The Joint Commission E/M Code for hospital outpatient encounter as defined in OP Appendix A, OP Table 1.0, and An ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1 Documentation of LVSD < 40% Patients enrolled in Clinical Trial Patients who with hyperkalemia Patient with renal dysfunction or dialysis Patients with a documented Reason for No Aldosterone Receptor Antagonist Prescribed for LVSD in the Outpatient Setting 42 © Copyright, The Joint Commission ACHF-01c Excluded Populations Denominator: Birthdate Clinical Trial Discharge Status E/M Code ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Principal Code 43 © Copyright, The Joint Commission ACHF-01c Data Elements ACHF-01c Data Elements 44 © Copyright, The Joint Commission Denominator: LVSD < 40% Outpatient Encounter Date Reason for No Aldosterone Receptor Antagonist Prescribed for LVSD in the Outpatient Setting ACHF-01c Data Elements 45 © Copyright, The Joint Commission Numerator: Aldosterone Receptor Antagonist Prescribed for LVSD in the Outpatient Setting 46 © Copyright, The Joint Commission ACHF-01c Algorithm Highlights ACHF-07 Discussion of Advance Directives Numerator: Patients who have an advance directive documented in the medical record OR documentation of a one-time discussion of advance care planning with a healthcare provider 47 © Copyright, The Joint Commission Denominator: All heart failure patients ACHF-07 Included Populations 48 © Copyright, The Joint Commission Discharges with ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and Patients enrolled in a Clinical Trial Patients who left against medical advice (AMA) ACHF-07 Data Elements 49 © Copyright, The Joint Commission Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date Discharge Disposition ACHF-07 Data Elements Denominator: ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code 50 © Copyright, The Joint Commission Numerator: Advance Directives 51 © Copyright, The Joint Commission ACHF-07 Algorithm Highlights ACHF-07a Hospital Outpatient Discussion of Advance Directives Numerator: Outpatients who have an advance directive documented in the medical record OR documentation of a one-time discussion of advance care planning with a healthcare provider 52 © Copyright, The Joint Commission Denominator: All heart failure patients ACHF-07a Included Populations 53 © Copyright, The Joint Commission E/M Code for hospital outpatient encounter as defined in OP Appendix A, OP Table 1.0, and An ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1 Denominator: Birthdate Discharge Status E/M Code ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code Outpatient Encounter Date Numerator: Advance Directives 54 © Copyright, The Joint Commission ACHF-07a Data Elements 55 © Copyright, The Joint Commission ACHF-07a Algorithm Highlights © Copyright, The Joint Commission Inpatient Setting ACHF-02 Post-Discharge Appointment for Heart Failure Patients Numerator: Patients for whom a follow-up appointment for an office or home health visit for management of heart failure was scheduled within 7 days post-discharge and documented including location, date, and time 57 © Copyright, The Joint Commission Denominator: All heart failure patients discharged from a hospital inpatient setting to home or home care ACHF-02 Included Populations Discharges with ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and 58 © Copyright, The Joint Commission A discharge to home, home care, or court/law enforcement ACHF-02 Excluded Populations 59 © Copyright, The Joint Commission Patients discharged to locations other than home, home care, or law enforcement Patients enrolled in Clinical Trial Patients with a documented Reason for No Post-Discharge Appointment Within 7 Days Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date Discharge Disposition ICD-9-CM Other Procedure Codes 60 © Copyright, The Joint Commission ACHF-02 Data Elements ACHF-02 Data Elements Numerator: Post-Discharge Appointment Scheduled Within 7 Days 61 © Copyright, The Joint Commission Denominator: ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code Reason for No Post-Discharge Appointment Within 7 Days 62 © Copyright, The Joint Commission ACHF-02 Algorithm Highlights ACHF-03 Care Transition Record Transmitted Numerator: Care transition record transmitted to a next level of care provider within 7 days of discharge with a copy in the medical record containing ALL of the following components: © Copyright, The Joint Commission Denominator: All heart failure patients discharged from a hospital inpatient setting to home or home care Reason for hospitalization Procedures performed during hospitalization Treatment / services provided Condition / functional status at discharge Discharge medications Follow-up treatment / services needed Caregiver / social support Next level of care provider contact info Post-discharge appointment info 64 © Copyright, The Joint Commission ACHF-03 Care Transition Record Components ACHF-03 Included Populations Discharges with ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and 65 © Copyright, The Joint Commission A discharge to home, home care, or court/law enforcement ACHF-03 Excluded Populations Patients discharged to locations other than home, home care, or law enforcement 66 © Copyright, The Joint Commission Patients enrolled in Clinical Trial Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date Discharge Disposition ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code 67 © Copyright, The Joint Commission ACHF-03 Data Elements ACHF-03 Data Elements © Copyright, The Joint Commission Numerator: Care Transition Record -Condition or Functional Status at Discharge Care Transition Record -Designated Patient Caregiver or Social Support Care Transition Record -Discharge Medications Care Transition Record Given to Patient/Caregiver Care Transition Record -Follow-up Treatment and Services Needed Care Transition Record -Location, Date, and 68 Time of Post-Discharge Appointment Numerator: Care Transition Record -Next Level of Care Provider Contact Information Care Transition Record Present Care Transition Record -Procedures Performed During Hospitalization Care Transition Record -Reason for Hospitalization Care Transition Record- Treatment/Services Provided Discharge Date 69 © Copyright, The Joint Commission ACHF-03 Data Elements 70 © Copyright, The Joint Commission ACHF-03 Algorithm Highlights 71 © Copyright, The Joint Commission ACHF-03 Algorithm Highlights pt2 72 © Copyright, The Joint Commission ACHF-03 Algorithm Highlights pt3 ACHF-08 Post-Discharge Evaluation for Heart Failure Patients 73 © Copyright, The Joint Commission Denominator: All heart failure patients discharged from a hospital inpatient setting to home or home care AND patients leaving against medical advice (AMA) ACHF-08 Post-Discharge Evaluation for Heart Failure Patients – Heart failure symptoms – Weight and fluid status – Diet and sodium intake – Medication compliance and adverse drug reactions – Activity 74 © Copyright, The Joint Commission Numerator: Patients who have a documented re-evaluation conducted via phone call or home visit within 72 hours after discharge addressing ALL of the following components: ACHF-08 Included Populations 75 © Copyright, The Joint Commission Discharges with ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and A discharge to home, home care, or court/law enforcement Patients who left against medical advice (AMA) Denominator: Admission Date Birthdate Clinical Trial Comfort Measures Only Discharge Date Discharge Disposition ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code 76 © Copyright, The Joint Commission ACHF-08 Data Elements 77 © Copyright, The Joint Commission ACHF-08 Algorithm Highlights © Copyright, The Joint Commission 78
