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  • Measure Summary
  • NQMC:010003
  • Mar 2015
  • NQF-Endorsed Measure

Heart failure (HF): percentage of HF patients discharged from a hospital inpatient setting to who have a documented re-evaluation for symptoms worsening and treatment compliance conducted within 72 hours after discharge.

The Joint Commission. Disease-specific care certification program. Advanced certification heart failure: performance measurement implementation guide. Oakbrook Terrace (IL): The Joint Commission; 2015 Mar. 76 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess percentage of heart failure (HF) patients discharged from a hospital inpatient setting who have a documented re-evaluation for symptoms worsening and treatment compliance conducted within 72 hours after discharge.

Rationale

Today, hospitals and providers in the United States are challenged to provide high-quality, cost-effective healthcare. Preventing readmissions to the hospital is one opportunity to control costs and deliver quality care. According to Hospital Compare, the national 30-day readmission rate for heart failure is 24.7%. Jha and colleagues (2009) have concluded that data collection for discharge planning and instruction measures has not reduced unnecessary readmissions. Alternative interventions are needed to meet heart failure treatment goals post-discharge. Ongoing evaluation of patient symptoms and their functional consequences may help prevent hospital readmissions

The Joint Commission's 2014 Disease-Specific Care Advanced Certification Heart Failure standards require that care, treatment, and services are provided in a planned and timely manner. Compliance with this standard is demonstrated through a re-evaluation of the patient by a program team member within 72 hours after inpatient discharge. The re-evaluation may be conducted via phone call, home visit, or scheduled office appointment.

Evidence for Rationale

Hoyt RE, Bowling LS. Reducing readmissions for congestive heart failure. Am Fam Physician. 2001 Apr 15;63(8):1593-8. PubMed External Web Site Policy

Jha AK, Orav EJ, Epstein AM. Public reporting of discharge planning and rates of readmissions. N Engl J Med. 2009 Dec 31;361(27):2637-45. PubMed External Web Site Policy

The Joint Commission. Disease-specific care certification program. Advanced certification heart failure: performance measurement implementation guide. Oakbrook Terrace (IL): The Joint Commission; 2015 Mar. 76 p.

The Joint Commission. The Joint Commission's 2014 disease-specific care certification manual: advanced certification in heart failure addendum. Oakbrook Terrace (IL): The Joint Commission; 2014.

Primary Health Components

Heart failure; post-discharge evaluation

Denominator Description

All heart failure patients discharged from a hospital inpatient setting to home or home care AND patients leaving against medical advice (AMA) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who have a documented re-evaluation conducted via phone call or home visit within 72 hours after discharge

Type of Evidence Supporting the Criterion of Quality for the Measure

  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Certification

Collaborative inter-organizational quality improvement

Internal quality improvement

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Timeliness

Case Finding Period

Discharges January 1 through December 31

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions

  • Discharges with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Principal Diagnosis Code for heart failure (HF) as defined in the appendices of the original measure documentation, and
  • A discharge to home, home care, or court/law enforcement
  • Patients who left against medical advice (AMA)

Exclusions

  • Patients who had a left ventricular assistive device (LVAD) or heart transplant procedure during hospital stay (ICD-9-CM procedure code for LVAD and heart transplant as defined in the appendices of the original measure documentation)
  • Patients less than 18 years of age
  • Patient who have a Length of Stay greater than 120 days
  • Patients with Comfort Measures Only (as defined in the Data Elements) documented
  • Patients enrolled in a Clinical Trial (as defined in the Data Elements)
  • Patients discharged to locations other than home, home care or law enforcement

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

System factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients who have a documented re-evaluation conducted via phone call or home visit within 72 hours after discharge

Exclusions
None

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

  • Advanced Certification Heart Failure (ACHF) Initial Patient Population Algorithm Flowchart
  • ACHF-06: Post-Discharge Evaluation for Heart Failure Patients Flowchart

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Does not apply to this measure

Standard of Comparison

Internal time comparison

Original Title

ACHF-06: post-discharge evaluation for heart failure patients.

Measure Collection Name

Advanced Certification in Disease-specific Care Measures

Measure Set Name

Heart Failure Standardized Performance Measures

Submitter

The Joint Commission - Health Care Accreditation Organization

Developer

The Joint Commission - Health Care Accreditation Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Endorser

National Quality Forum

NQF Number

2443

Date of Endorsement

2015 Jun 29

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Mar

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

2015 Jul

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Source(s)

The Joint Commission. Disease-specific care certification program. Advanced certification heart failure: performance measurement implementation guide. Oakbrook Terrace (IL): The Joint Commission; 2015 Mar. 76 p.

Measure Availability

Source available from The Joint Commission Web site External Web Site Policy.

For more information, contact The Joint Commission at One Renaissance Blvd., Oakbrook Terrace, IL 60181; Phone: 630-792-5800; Fax: 630-792-5005; Web site: www.jointcommission.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 21, 2015. The information was verified by the measure developer on June 15, 2015.

The information was reaffirmed by the measure developer on April 6, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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