Process of care performance measures and long-term outcomes in patients hospitalized with heart failure.
Process of care performance measures and long-term outcomes in patients hospitalized with heart failure.
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DOI：
10.1097/mlr.0b013e3181ca3eb4
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发表时间：
2010-03
期刊：
影响因子：
3
通讯作者：
Curtis LH
中科院分区：
文献类型：
--
作者：
Patterson ME;Hernandez AF;Hammill BG;Fonarow GC;Peterson ED;Schulman KA;Curtis LH
最近的努力，以改善心力衰竭住院患者的护理集中在基于过程的性能指标。支持当前过程测量和患者结果之间联系的数据很少。检查遵守医院级流程措施与长期患者死亡率和再入院率之间的关系。分析来自国家临床登记处的数据，该数据与来自医疗保险和医疗补助服务中心（CMS）的结果数据相关联。2003年3月至2004年12月期间，22750名医疗保险按服务收费的受益人参加了在住院心力衰竭患者中启动救生治疗的有组织计划（OPTIMIZE-HF）。1年死亡率; 1年时的心血管再入院;以及对医院级流程措施的依从性，包括出院指导、左心室功能评估、出院时血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂处方、出院时β受体阻滞剂处方以及合格患者的戒烟咨询。在5个过程措施中，医院符合率范围为52%至86%。未校正的1年总死亡率和心血管再入院率分别为33%和40%。在协变量调整分析中，CMS综合评分与1年死亡率（风险比，1.00; 95%置信区间，0.98-1.03; P = 0.91）或再入院（风险比，1.01; 95%置信区间，0.99-1.04; P = 0.37）无关。当前CMS过程测量与死亡率无关，尽管出院时β受体阻滞剂处方与较低的死亡率独立相关（风险比，0.94; 95%置信区间，0.90-098; P = .004）。根据当前CMS指标判断，心力衰竭的医院流程性能与出院后1年内的患者结局无关，这就质疑了现有CMS指标是否可以准确区分心力衰竭的医院护理质量。
Recent efforts to improve care for patients hospitalized with heart failure have focused on process-based performance measures. Data supporting the link between current process measures and patient outcomes are sparse. To examine the relationship between adherence to hospital-level process measures and long-term patient-level mortality and readmission. Analysis of data from a national clinical registry linked to outcome data from the Centers for Medicare & Medicaid Services (CMS). 22750 Medicare fee-for-service beneficiaries enrolled in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) between March 2003 and December 2004. Mortality at 1 year; cardiovascular readmission at 1 year; and adherence to hospital-level process measures, including discharge instructions, assessment of left ventricular function, prescription of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge, prescription of beta-blockers at discharge, and smoking cessation counseling for eligible patients. Hospital conformity rates ranged from 52% to 86% across the 5 process measures. Unadjusted overall 1-year mortality and cardiovascular readmission rates were 33% and 40%, respectively. In covariate-adjusted analyses, the CMS composite score was not associated with 1-year mortality (hazard ratio, 1.00; 95% confidence interval, 0.98-1.03; P = .91) or readmission (hazard ratio, 1.01; 95% confidence interval, 0.99-1.04; P = .37). Current CMS process measures were not independently associated with mortality, though prescription of beta-blockers at discharge was independently associated with lower mortality (hazard ratio, 0.94; 95% confidence interval, 0.90-098; P = .004). Hospital process performance for heart failure as judged by current CMS measures is not associated with patient outcomes within 1 year of discharge, calling into question whether existing CMS metrics can accurately discriminate hospital quality of care for heart failure.