FROM: Theodore O. Will, Chief Executive Officer
DATE: Jul 29, 1999
SUBJECT: Congestive Heart Failure (CHF) in New York State - Impact Assessment
IPRO CONTACTS:
Charles Stimler, MD, MPH, Clinical Coordinator - ext. 514
Terri Straub, R.N., M.B.A., Senior Director, Improvement Strategies/QI - Ext. 410
Enclosed is a copy of IPRO's impact report on the Management of Congestive Heart Failure (CHF) in New York State. The goal of this project was to improve the processes involved in CHF diagnosis, classification, treatment, and patient education among inpatients. The quality indicators developed for this study were based on a study group's interpretation of the AHCPR Clinical Practice Guideline "Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction". IPRO had published two baseline measurement studies on CHF in early 1996 and since then has been involved in developing clinical interventions with hospitals throughout the state. IPRO Interventions performed statewide included distributions of baseline reports to all hospitals, implementation of quality improvement plans by 113 hospitals, conference calls by IPRO physicians with 149 hospitals, and distribution to all hospitals of a CHF patient education booklet and CHF clinical pathway which were authored by a collaborative group of 16 hospitals in the Western New York region (and supported by the Western New York Healthcare Association).
The enclosed impact report contains the results of remeasurements of quality indicators which were originally studied in 1996. The results of this impact remeasurement demonstrate statistically and clinically significant improvements in several of the quality indicators as compared with the baseline measurements. Specifically, significant statewide improvements were noted in the utilization rate of angiotensin converting enzyme (ACE) inhibitor drugs and angiotensin receptor blockers (ARB) in the treatment of patients who were eligible for such drug therapy. In addition, statewide improvements were noted in the patient education categories of General CHF Counseling and Dietary Recommendations. The Western New York region (which was also studied separately) showed these same significant improvements and also demonstrated a significant improvement in the documentation of left ventricular ejection fraction.
Please note that attached to this memo is an expanded report response form. Since CHF is one of the major topic areas chosen by HCFA to be emphasized in the 6th Scope of Work, it is extremely important to be sure to fill out this form completely and return it to IPRO in the envelope provided by the due date suggested. Your prompt response will be critical to ensure the success of the future CHF efforts.
IPRO urges all hospitals in New York State to be aware of the AHCPR recommendations regarding the diagnosis and treatment of CHF and to encourage increased Medicare beneficiary involvement in CHF patient education activities.
Should you have any questions or comments with regard to this material, please feel free to call one of the above-mentioned contacts.
The goal of IPRO's Congestive Heart Failure (CHF) quality improvement project was to improve the process of diagnosis, treatment, and patient education regarding CHF. This project was based on the standards of care outlined in the Agency for Health Care Policy and Research's (AHCPR) Guideline "Heart Failure: Evaluation and Care of Patients With Left-Ventricular Systolic Dysfunction" released in 1994. The AHCPR suggested the use of left-ventricular ejection fraction measurements to determine left ventricular function, the use of angiotensin converting enzyme (ACE) inhibitors for patients with systolic dysfunction, and comprehensive patient education. This study focused on these aspects of the AHCPR's Guideline and also analyzed the use of both ACE inhibitors and angiotensin receptor blockers (ARB) among patients with CHF and documented systolic dysfunction.
Retrospective chart review was conducted for both a statewide random sample as well as a collaborator-based sample in the greater Buffalo area. Specific quality indicators from both initial baseline and subsequent impact samples were selected for study. Between baseline and impact periods IPRO conducted both statewide educational interventions as well as more focused regional interventions. The more focused interventions took place at collaborating hospitals in the greater Buffalo area of Western New York State comprised of eight contiguous counties. All interventions were directed toward improving awareness of generally accepted standards of care regarding CHF and providing tools to hospitals to better assist health care workers in delivering superior quality care. Impact outcomes were measured in both the statewide as well as in the Western New York regions.
Between the baseline and impact periods there was a statistically significant improvement in several of the quality indicators which demonstrated improved CHF care. Left ventricular ejection fraction documentation significantly improved in the Western New York region, and the use of ACE inhibitors and/or ARB significantly improved in both the statewide and Western New York region. Patient education significantly improved as well as the dietary recommendation categories for both groups.
Subsequent to the impact sample, an additional 28 month statewide random sample was selected. The data derived from analysis of this sample provide evidence of continuing improvements in the management of CHF.