Transcript GWTG-HF: Quality Measures - American Heart Association

2017 Get With The Guidelines-Heart
Failure Measure Updates
Thursday January 26, 2017
11:00am – 12:00pm CT
Presenters:
Gregg C. Fonarow, MD, FACC, FAHA, FHFSA
Christina Sterzing, RHIA
Meet Our Presenters:
Gregg C. Fonarow, MD, FACC, FAHA
The Eliot Corday Professor of Cardiovascular Medicine and Science
Co-Chief of Clinical Cardiology UCLA Division of Cardiology
Director, Ahmanson-UCLA Cardiomyopathy Center
Co-Director, UCLA Preventative Cardiology Program
Christina Sterzing, RHIA
Quality & Health IT
American Heart Association, National Center
[email protected]
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Core Principles of Get With The Guidelines
• Focus is on quality improvement
• Success is in translating guidelines into clinical practice in the hospital setting
• Capitalizing on the ‘teachable moment’ for both patient and family
• Data drives change- moving from simply collecting data to driving process and system
improvements by measuring trends in compliance in real time
• Celebrating success of improved compliance within one hospital, in a region, and
across the country!
• Best Practice sharing within the network of hospitals
• Evaluation through analytics to highlight key insights as well as consider future efforts
GWTG-HF Webinar Overview
• Update on GWTG-HF scope
• Current achievement and quality measure performance and awards
• Highlights of GWTG-HF research
• PMT Update and revised/new measures
• Update on Target: Heart Failure and Rise Above Heart Failure
• New developments in Hospital Accreditation and Certification
• Questions
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Number of records
GWTG-HF: Data Submission
October 2016
GWTG-HF: Achievement Measures
100.00%
90.00%
80.00%
70.00%
60.00%
Compliance
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Post
EvidenceACEI or ARB
Discharge
Composite
100%
LV Function
Based Beta Beta Blocker
Discharge
at D/C for LV
Appointment
Performance Compliance
Measurement
Blocker at D/C Discharge
Instructions
SD
for HF
Measure*
Measure*
for LVSD
patients
Baseline
90.10%
81.20%
61.00%
87.30%
39.30%
69.70%
80.30%
62.10%
Current
98.64%
91.68%
92.60%
97.90%
74.64%
95.42%
96.68%
92.52%
Achievement Measure
* Modified to include Beta Blocker at Discharge and Discharge Instructions rather than Evidence-Based Beta Blocker at D/C and Post Discharge Appointment
Baseline = Admissions Jan2005 – Dec2005
October 2016
Current = Overall
GWTG-HF: Quality Measures (1)
100.00%
90.00%
80.00%
Compliance
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Warfarin at D/C
Aldostrone anatagonist at
D/C for LVSD
Hydralazine/Isosorbide at
D/C for AA
ICD Counseling or ICD
placed or prescribed at D/C
Baseline
57.30%
19.90%
10.80%
31.30%
Current
84.61%
39.62%
29.14%
54.10%
Quality Measure
Baseline = Admissions Jan2005 – Dec2005
October 2016
Current = Overall
GWTG-HF: Quality Measures (2)
100.00%
90.00%
Compliance
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Pnemococcal
Vaccine
Influenza Vaccine
Follow-up visit within
7 days
DVT Management
CRT placed or
prescribed at
discharge
Baseline
22.90%
17.70%
61.90%
25.40%
39.90%
Current
67.50%
78.00%
79.03%
85.42%
49.78%
Quality Measure
Baseline = Admissions Jan2009 – Dec2009
October 2016
Current = Overall
GWTG-Heart Failure Awards
250
211
189
200
168
172
164
148
145
150
131
111
100
81 87
74 77
92
86
80
62
60
43
50
24
6
0
Bronze
Silver
Silver Plus
Gold
Gold Plus
Target: HF Honor Roll
22
14
0
0
31 26
11
23
41 35
65
51
48
28
23 22
30
48
32
42
17
2010
2011
2012
2013
2014
2015
2016
74
77
6
145
24
0
81
87
14
168
86
0
43
60
22
164
131
11
31
26
23
92
148
41
35
28
48
62
189
65
23
22
30
51
172
80
48
17
32
42
211
111
Most Comprehensive and Up to Date HF Quality Measure Set
Achievement Measures
•
•
•
•
ACEI/ARB/ARNI at Discharge (Updated)
Evidence-Based Specific Beta Blockers
Measure LV Function
Post-Discharge Appointment for Heart
Failure Patients
Quality Measures
• ARNI at Discharge (New)
• Aldosterone Antagonist at Discharge
• Anticoagulation for Atrial Fibrillation and
Atrial Flutter
• Hydralazine Nitrate at Discharge
• DVT Prophylaxis
• CRT-D or CRT-P Placed or Prescribed
at Discharge
• ICD Counseling Provided or Prescribed
or Placed at Discharge
• Influenza Vaccination During Flu
Season
• Pneumococcal Vaccination
• Follow-Up Visit Scheduled Within 7
Days or Less
Reporting Measures
• Ivabradine at
Discharge (New)
• Blood Pressure
Control at Discharge
• Beta Blocker at
Discharge
• Beta Blocker
Medication at
Discharge
• Lipid-Lowering
Medications at
Discharge
• Omega-3 Fatty Acid
Supplement Use at
Discharge
• Diabetes Treatment
• Diabetes Teaching
• Smoking Cessation
• Discharge
Instructions
• ICD Placed or
Prescribed at
Discharge
• Advanced Care Plan
• QRS Duration
Documented
• HF Disease
Management
Program Referral
• Follow-Up Visit or
Contact Within 48
Hours of Discharge
Scheduled
2016 GWTG-HF Publications
•
Patel D, Shah R, Bhatt D, Liang L, Schulte P, DeVore A, Hernandez A, Heidenreich P, Yancy C, Fonarow G. Guideline-Appropriate Care and In-Hospital Outcomes in
Patients with Heart Failure in Teaching and Non-Teaching Hospitals: Findings from Get With The Guidelines-Heart Failure. Circulation: Cardiovascular Quality and
Outcomes. 2016;CIRCOUTCOMES.115.002542 [Epub 10/25/16] *Strategic
•
Frizzell, Jarrod D. Prediction of 30-day All-Cause Readmissions in Patients Hospitalized for Heart Failure: Comparison of Machine-Learning and Other
Statistical Approaches. JAMA Cardiology (In Press) *AHA Young Investigator Database Seed Grant Awardee
•
Kelly J, Hammill B, Doll J, Felker GM, Heidenreich P, Bhatt D, Yancy C, Fonarow G, Hernandez A. The Potential Impact of Expanding Cardiac Rehabilitation in Heart
Failure (Research Letter). JACC [Epub 8/22/16]
•
Echouffo-Tcheugui J, Xu H, DeVore A, Schulte P, Butler J, Yancy C, Bhatt D, Hernandez A, Heidenreich P, Fonarow G. Temporal Trends and Factors Associated With
Diabetes Mellitus Among Patients Hospitalized With Heart Failure - Findings From Get With The Guidelines-Heart Failure Registry. Am Heart J 2016;182:9-20. [Epub
8/27/16]
•
Pandey, Ambarish. Association of 30-day Readmission Metric for Heart Failure under the Hospital Readmissions Reduction Program with Quality of Care and
Outcomes. JACC HF (in press) simultaneous publication in JACC HF with AHA Scientific Sessions 2016 abstract- November 15, 2016 *AHA Young Investigator Database
Seed Grant Awardee
•
Shreibati J, Sheng S, Fonarow G, DeVore A, Yancy C, Bhatt D, Schulte P, Peterson E, Hernandez A, Heidenreich P. Heart failure medications prescribed at discharge
for patients with left ventricular assist devices. Am Heart J 2016;179:99-106 [EPub 6/2316] *AHA Young Investigator Database Seed Grant Awardee
•
Hess P, Hernandez A, Bhatt D, Hellkamp A, Yancy C, Schwamm L, Peterson E, Schulte P, Fonarow G, Al-Khatib S. Sex and Race/Ethnicity Differences in Implantable
Cardioverter-Defibrillator Counseling and Use Among Patients Hospitalized With Heart Failure: Findings from the Get With The Guidelines-Heart Failure Program.
Circulation. 2016;CIRCULATIONAHA.115.021048 [Epub 8/4/16]
2016 GWTG-HF Publications (continued)
•
Bergethon K, Ju C , DeVore A, Hardy NC, Fonarow G, Yancy C, Heidenreich P, Bhatt D, Peterson E, Hernandez A. Trends in 30-Day Readmission
Rates for Patients Hospitalized With Heart Failure: Findings From the Get With The Guidelines-Heart Failure Registry. Circ Heart Fail. 2016 Jun;9(6).
pii: e002594. doi: 10.1161/CIRCHEARTFAILURE.115.002594 [Epub 6/16/16]
•
Pandey A, Golwala H, DeVore AD, Lu D, Madden G, Bhatt DL, Schulte PJ, Heidenreich PA, Yancy CW, Hernandez AF, Fonarow GC. Trends in the Use
of Guideline-Directed Therapies among Dialysis Patients Hospitalized with Systolic Heart Failure: Findings from the American Heart Association Get
With The Guidelines-Heart Failure Program. JACC Heart Fail. 2016 Aug;4(8):649-61. doi: 10.1016/j.jchf.2016.03.002. [Epub 5/11/16]
•
Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF, Butler J, Yancy CW, Fonarow GC. Precipitating Clinical Factors, Heart Failure
Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction. JACC Heart
Fail. 2016 Jun;4(6):464-72. doi: 10.1016/j.jchf.2016.02.017 [Epub 6/1/16]
•
Khazanie P, Liang L, Curtis LH, Butler J, Eapen ZJ, Heidenreich PA, Bhatt DL, Peterson ED, Yancy CW, Fonarow GC, Hernandez AF. Clinical
Effectiveness of Hydralazine-Isosorbide Dinitrate Therapy in Patients With Heart Failure and Reduced Ejection Fraction: Findings From the Get With
The Guidelines-Heart Failure Registry. Circ Heart Fail. 2016 Feb;9(2):e002444. doi: 10.1161/CIRCHEARTFAILURE.115.002444. PMID:26867758 [Epub
2/13/16]
•
Zeitler E, Hellkamp A, Schulte P, Fonarow G, Hernandez A, Peterson E, Sanders G, Yancy C, Al-Khatib S. Comparative Effectiveness of Implantable
Cardioverter Defibrillators for Primary Prevention in Women. Circulation: Heart Failure. 2016; 9: e002630 doi:10.1161/CIRCHEARTFAILURE.115.002630
[Epub 1/12/16]
Scope of Recent PMT Updates
ACE/ARB or ARNI at Discharge Measure Update (Achievement)
New ARNI at Discharge Measure (Quality 2017)
New Ivabradine at Discharge (Reporting 2017)
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Updated Achievement Measure
•
ACE/ARB/ARNI at Discharge (Achievement)
•
Background:
•
•
ARNI was approved for use in Summer 2015
•
ARNI was added to ACE/ARB or ARNI measure for inclusion in the denominator
New with this release:
•
4/1/2017
ARNI contraindications were added to measure exclusion criteria in October 2016
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Patients who have
contraindications to
ARNI are now
excluded from the
measure
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ACE/ARB/ARNI at Discharge (Rationale)
ARNI reduces CV
death or HF
hospitalization by
20%
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ARNI shows as
Class I
recommendation
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New Quality Measure
• ARNI at Discharge (Quality)
• Key Points
• ARNI reduces CV death or HF hospitalization by 20%
• Adding the Quality measure is the first step in tracking patients
who receive ARNI or over ACE or ARB alone
• This measure will be tested and validated, and may graduate to
an achievement measure in the future
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ARNI at Discharge Measure Description
Denominator:
•
•
All patients in the Initial Patient Population
Patients who have a documented ejection fraction of < 40% or a narrative description of LVF
consistent with moderate or severe systolic dysfunction
Exclusions:
•
•
•
•
Patients who left against medical advice; patients who expired; patients who expired in
medical facility; patients discharged/transferred to a federal healthcare hospital; patients
discharged to hospice; patients discharged/transferred to a critical access hospital (CAH)
Patients with contraindications or other reasons for not prescribing ARNI
Patients with contraindications to ARB
Comfort Measures Only
Numerator
•
Patients who were prescribed ARNI at discharge
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ARNI is recommended to
replace ACE or ARB in certain
patients
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ARNI at Discharge
New data element:
Reasons for not switching
to ARNI (excludes patient
from the denominator)
New Reporting Measure

Ivabradine at Discharge

New data elements under Ivabradine for Medications at Discharge
have been added

Move Ivabradine option from the Other Medications at Discharge to
Historic.

For discharges on or after Jan 1, 2017
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Ivabradine at Discharge Measure Description
Denominator:
•
All patients in the Initial Patient Population:
•
Who have a documented ejection fraction of ≤35% or a narrative description of LVF
consistent with moderate or severe systolic dysfunction AND
•
Whose heart rate closest to discharge is greater than or equal to 70 bpm AND
•
Who were either prescribed a beta-blocker at discharge or had a documented
contraindication to beta-blocker
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Measure Description (cont.)
Exclusions:
•
Patients who left against medical advice; patients who expired; patients who expired in
medical facility; patients discharged/transferred to a federal healthcare hospital; patients
discharged to hospice; patients discharged/transferred to a critical access hospital (CAH)
•
Patients with contraindications to Ivabradine
•
History or current finding of Atrial Fibrillation or Atrial Flutter
•
Comfort Measures Only
Numerator
• Ivabradine at Discharge
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Use of ARNI and
Ivabradine together
compliment
therapies
Ivabradine is a Class
IIA recommendation
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Ivabradine (Other Medications at
Discharge)
New data element to
capture Ivabradine
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Additional Webinars
For additional information, visit the Focus on Quality Webinars page:
http://www.heart.org/HEARTORG/General/Get-With-The-Guidelines-HFTarget-HFWebinars_UCM_447069
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Target: Heart Failure Program Update
Objectives:
• Re-launch the program including a comprehensive webinar outlining all program components
and benefits
• Enhance the Get With The Guidelines-Heart Failure Clinical Tools Library and the Target: Heart
Failure resources (Ex. Electronic tools, Heart Failure Care Plans, Interactive Workbook)
• Launch a monthly Target: Heart Failure Spotlight Series to focus on components of Target:
Heart Failure to increase clinician knowledge base
• Launch localized innovative Target: Heart Failure initiatives from within AHA’s seven regional
affiliates throughout the US.
• Increase hospitals enrolled and engagement
• Improved compliance in measures and number of awards
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RISE ABOVE HEART FAILURE UPDATE
COMING UP IN 2017 : A TARGETED OUTREACH TO
PROVIDERS
Convene, Educate, Amplify and
Measure
HF Summit on Feb. 10th
2017
Interactive Patient Experience Tool
• Through evidence based, connected heart health
HF content, Patients will be able to track and learn
about their symptoms, health data and medication
adherence
• They can set goals and measure their progress
• Through evaluations of lesson plans, track health
literacy
• Connect with their peers on the Support Network
Timeline: soft launch in Feb; and full
promotional launch in April 2017
• Finally through an evaluation at the end, measure
Quality of life
ACC and AHA
Setting a New Standard for
Hospital Accreditation Together
A New Collaboration Between ACC and AHA
•
Will offer all hospitals and institutions a single, comprehensive source of state-ofthe-art accreditation tools
•
These tools will bridge gaps and integrate evidence-based science, quality
initiatives, clinical best-practices and the latest ACC/AHA guidelines into
cardiovascular care processes
•
Leverages collective strengths, expertise and resources to identify and recognize high
performing and complex cardiovascular service lines
•
Provides unbiased, actionable and achievable benchmarks for all hospital and clinical
leaders to use as they work to raise their own standards of clinical performance.
•
Offers hospitals a single source for accreditation that ensures continuous and effective
quality improvement in cardiovascular care.
Beginning in 2017…
•
U.S. hospitals will have access to a suite of co-branded accreditation
services focused on all aspects of cardiac care, including:
•
•
•
•
•
•
chest pain
cardiac catheterization
atrial fibrillation
heart failure
other cardiovascular conditions.
The collaborative will develop a multi-faceted cardiac accreditation
program to enable hospitals and health systems to achieve the highest
standard of cardiac care for all patients.
Stay informed on accreditation
[email protected]
To receive further updates visit
www.cardiacaccreditation.org
Contact Us to Learn More
Steve Dentel BSN, RN, CPHQ
National Director, Field Programs and Integration
[email protected]
GWTG-Heart Failure
Stay informed on the latest updates
from all of the
Get With The Guidelines programs.
Sign Up for Focus on Quality e-
Tanya Lane Truitt, RN MS
Sr. Program Manager Quality Systems Improvement
[email protected]
Liz Olson
Program Manager, Get With The Guidelines – Heart Failure
[email protected]
Communications
Thank you for your active participation
and contributions to GWTG-HF!
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©2010, American Heart Association