Download Heart Failure Core Measures

Heart Failure Core Measures
GMEC QI Presentation
Congestive Heart Failure

Heart failure accounts for more than 700,000
hospitalizations every year.

Heart Failure is associated with high rates of
mortality and morbidity.
Core Measures
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standardized sets of valid, reliable and evidence
based measures of care
describe the level of performance with regard to
patient outcomes
provide a “comparative” measurement that is
standardized and risk adjusted.
Core Measures drive the CMS Quality Initiatives (i.e.,
pay for performance)
CHF Core Measures Team

Multidisciplinary:
o
o
o
o
o
o
o
o
Internal Medicine/ Hospital Medicine
Cardiology
Nursing
Pharmacy
Information Technology Services
Medical Records
Performance Improvement
Case Management
CHF Core Measures Team

Medicine Program/House Staff Leadership:
o
o
o
o
o
Developed a set of “discharge instructions” specific
to Congestive Heart Failure (CHF)
Added “smoking cessation” to all d/c instructions
Developed MIS “physician” prompt/reminder for
ACEI/ARB inclusion in CHF d/c instruction pathway
Ensure MIS d/c instructions are comprehensive &
include CHF “reminders” for patients with CHF as a
secondary diagnosis
Consolidated d/c instructions and d/c summaries
for patients with 2-5 day length of stay (LOS)
Heart Failure Core Measure Set
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Discharge Instructions
LVF Assessment
ACEI/ARB for LVSD
Adult Smoking Cessation
Advice/Counseling
Discharge Instructions
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Activity
Diet
Follow-up
Medications
Symptoms Worsening
Weight Monitoring
Discharge Instructions
100%
Compliance
90%
80%
70%
60%
50%
06 06 06 07
07 07 07 08
08 08 08 09
06 06
07 07
08 08
09
06
n- ar- ay- Jul- ep- ov- an- ar- ay- Jul- ep- ov- an- ar- ay- Jul- ep- ov- an- ara
J
J
J
J
M
M
M
M
S
N
S
N
S
N
M
M
M
Left Ventricular Systolic Function

LVF Assessment (Before arrival, during
hospitalization, planned for after discharge)
Left Ventricular Systolic Function
100%
Compliance
98%
96%
94%
92%
90%
06 06 06 07 07 07
07 07 07 08 08 08
08 08 08 09 09
06 06 06
n- ar- ay- Jul- ep- ov- an- ar- ay- Jul- ep- ov- an- ar- ay- Jul- ep- ov- an- ara
J
J
J
J
M
M M
M
M
S
N
S
N
S
N
M
M
ACE-I or ARB for LVSD
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ACE-I or ARB Prescribed at Discharge
Contraindication to ACE-I or ARB @ Discharge
ACE-I or ARB for LVSD
100%
Compliance
98%
96%
94%
92%
90%
08
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0
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8
M
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ar
8
8
-0
r
Ap
08
M
ay
8
8
9
9
8
8
9
8
8
08
-0
-0
-0
-0
-0
-0
l-0
t-0
r-0
g
v
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np
c
n
u
c
a
u
u
o
e
e
a
e
J
J
O
J
A
F
M
S
N
D
Smoking Cessation
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Adult Smoking Counseling
Adult Smoking History
Smoking Cessation
100%
Compliance
95%
90%
85%
80%
06 06 06 07
07 07 07 08
08 08 08 09
06 06
07 07
08 08
09
06
n- ar- ay- Jul- ep- ov- an- ar- ay- Jul- ep- ov- an- ar- ay- Jul- ep- ov- an- ara
J
J
J
J
M
M
M
M
S
N
S
N
S
N
M
M
M
THANK YOU!!!
Medication Reconciliation
GMEC QI Presentation
Medication Reconciliation

Reconciliation is a process of comparing an accurate
list of a patient’s “current” medications — including
name, dosage, frequency, and route — with those
ordered for the patient while under the care of the
hospital

Reconciliation involves comparing the patient’s current
list of medications against the admission, transfer,
and/or discharge medication orders.
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Joint Commission National Patient Safety Goal #8
Admission Medication Reconciliation
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History & Physical is present
History & Physical is “current” version
History & Physical is “Dated” and “Timed”
Medication Inventory is complete
Medication Instructions are provided
Medication was “taken today”
History & Physical is present
100%
90%
80%
Compliance
70%
60%
50%
40%
30%
20%
10%
0%
8 08
9
8
9
7
7
8
8
8
9
7
8
8 08 08 08
7
8
07
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A M
O N
J
O
J
J
A
F
M
A
F
M
S
S
N
D
D
History & Physical is “current” version
100%
90%
80%
Compliance
70%
60%
50%
40%
30%
20%
10%
0%
8
7
8
8
8
8
9
8
-0 p-07 t-07 v-07 c-07 n-08 b-0 r-08 r-0 y-0 n-0 ul-0 g-0 p-08 t-08 v-08 c-08 n-09 b-0 r-09
g
c
c
p
Au Se O No De Ja Fe Ma A Ma Ju J Au Se O No De Ja Fe Ma
History & Physical -“Dated” and “Timed”
100%
90%
80%
Compliance
70%
60%
50%
40%
30%
20%
10%
0%
8
7
8
8
8
8
9
8
7
8
8
9
-0 p-0 t-07 v-07 c-07 n-0 b-0 r-08 r-0 y-0 n-0 ul-0 g-0 p-0 t-08 v-08 c-08 n-0 b-0 r-09
g
c
c
p
Au Se O No De Ja Fe Ma A Ma Ju J Au Se O No De Ja Fe Ma
Date
Time
Medication Inventory is complete
100%
90%
80%
Compliance
70%
60%
50%
40%
30%
20%
10%
0%
8
7
8
8
8
8
9
-0 p-07 t-07 v-07 c-07 n-08 b-0 r-08 r-0 y-08 n-0 ul-0 g-0 p-08 t-08 v-08 c-08 n-09 b-0 r-09
g
c
c
p
Au Se O No De Ja Fe Ma A Ma Ju J Au Se O No De Ja Fe Ma
Medication Instructions are provided
100%
90%
80%
Compliance
70%
60%
50%
40%
30%
20%
10%
0%
8
7
8
8
8
8
9
8
-0 p-07 t-07 v-07 c-07 n-08 b-0 r-08 r-0 y-0 n-0 ul-0 g-0 p-08 t-08 v-08 c-08 n-09 b-0 r-09
g
c
c
p
Au Se O No De Ja Fe Ma A Ma Ju J Au Se O No De Ja Fe Ma
Medication was “taken today”
100%
90%
80%
Compliance
70%
60%
50%
40%
30%
20%
10%
0%
8
7
8
8
8
8
9
-0 p-07 t-07 v-07 c-07 n-08 b-0 r-08 r-0 y-08 n-0 ul-0 g-0 p-08 t-08 v-08 c-08 n-09 b-0 r-09
g
c
c
p
Au Se O No De Ja Fe Ma A Ma Ju J Au Se O No De Ja Fe Ma
Please DO:

DO assure retention within the medical record of
patient-provided medication lists by writing “Retain in
Permanent Medical Record” across the top of the list.
 DO answer the MIS prompt regarding a patient’s
contraindication to ACEI and/or ARB therapy for
patients with LV dysfunction for whom you are not
prescribing an ACEI or ARB at discharge
 DO list the names & doses of all medications the
patient will be taking after discharge within the MIS
discharge instructions or within any other discharge
instructions given to the patient (e.g., Heart Failure
Service discharge instruction form).
Please DON’T:
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DO NOT write “resume home medications” or “resume
current medications” or “follow home regimen” on the
discharge note, on the discharge instructions, or on the
dictated discharge summary.
DO NOT list or mention any discharge medications in a
problem list within the dictated discharge summary or
discharge progress note.
DO NOT list or mention any discharge medications.
Doing so forces a (100%) reconciliation process with
the medications on the MIS discharge instructions. A
single non-match causes non-compliance (0%).
Heart Failure Core Measures
& Medication Reconciliation

Keep Up the Good Work!

Pick Up & Follow the Trend!

Let’s Take It to the Next Level!
THANK YOU