The Impact of Quality Metrics on Outcomes Among Elderly Heart Failure Patients
质量指标对老年心力衰竭患者预后的影响
基本信息
- 批准号:10181108
- 负责人:
- 金额:$ 14.15万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2018
- 资助国家:美国
- 起止时间:2018-08-25 至 2023-06-30
- 项目状态:已结题
- 来源:
- 关键词:AcuteAcute Renal Failure with Renal Papillary NecrosisAdmission activityAdrenergic beta-AntagonistsAgeAngiotensin II ReceptorAngiotensin-Converting Enzyme InhibitorsAttentionCardiologyCaringCharacteristicsClinicalClinical ManagementClinical TrialsClinical assessmentsCreatinineDataDimensionsDrug usageEFRACEffectivenessElderlyEnrollmentEvaluationFoundationsFutureGuidelinesHeart failureHeterogeneityHospitalizationHospitalsHypotensionIncentivesIncidenceInterviewKnowledgeLinkMeasurementMeasuresMedicareMedicare Part AMethodsModelingOutcomePatient CarePatient PreferencesPatientsPerformancePharmaceutical PreparationsPlayPopulationPopulation HeterogeneityPotassiumProviderQuality of CareQuality of lifeRandomized Controlled TrialsRecording of previous eventsRegistriesRiskRoleStructureSymptomsSystemVariantWorkbasebeneficiarycare providersclinical carecomorbiditycomparative effectivenessdata registryeconomic implicationfrailtyhigh riskhospital readmissionimprovedinterestmedication safetymortalitymultiple chronic conditionsnext generationolder patientpatient populationpatient responsepaymentpersonalized approachpreferenceprogramsrandomized trialresearch clinical testingside effect
项目摘要
Project Summary/Abstract
1 Quality of care has become a significant component of provider evaluation and reimbursement. As alternative payment
2 models gain popularity and the new Merit-Based Incentive Payment (MIPS) program rolls out, how quality is defined and
3 measured will become increasingly important for patients, providers and payers. In the field of cardiology, most quality
4 metrics are based on findings from large, randomized trials. While robust, randomized trials can be limited in their
5 generalizability, owing to narrowly defined enrollment criteria and the underrepresentation of certain patient populations.
6 This can result in a mismatch between the population in which a therapy has been proven effective and the population in
7 which quality metrics require it use. This, in turn, can create a system of quality measurement that inadvertently incentives
8 non-evidenced based practice or unfairly penalizing certain providers. An example is the use of neurohormonal therapy in
9 elderly patients with heart failure and reduced ejection fraction (HFrEF). Neurohormonal therapies, which include
10 angiotensin converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB) and beta-blockers, are the
11 cornerstone of HFrEF therapy and their use now defines quality in HFrEF care. While neurohormonal therapies are
12 undoubtedly beneficial in the vast majority of HFrEF patients, elderly patients ≥75 years old were underrepresented in the
13 landmark studies that evaluated the efficacy and safety of these drugs. Since neurohormonal therapies carry a non-trivial
14 risk of side effects, it is possible that the short term risks of therapy outweigh the longer term benefits in certain elderly
15 patients. At present however, neither clinical guidelines nor quality metrics account for this known heterogeneity among
16 elderly HFrEF beneficiaries. To better understand the impact of neurohormonal therapy on elderly HFrEF patients,
17 determine how best to use neurohormonal therapy in elderly HFrEF patients and more effectively measure quality of care
18 among elderly HFrEF patients, a 3-part analysis using administrative, registry and qualitative data is proposed. The
19 project aims to (1) use Medicare data to determine whether and how the clinical benefits of neurohormonal therapy vary
20 by age; (2) to use the national registry data linked with Medicare data to determine characteristics that predict likelihood
21 to benefit from neurohormonal therapy among elderly HFrEF patients and simulate the effectiveness of a targeted
22 approach to therapy using the identified characteristics; and (3) to use semi-structured patient interviews to determine the
23 aspects of care that define “high quality care” for elderly HFrEF patients. This work has the potential to both improve the
24 quantity of care and the quality of life for elderly HFrEF patients as well as improve our current method of quality
25 measurement in heart failure. First, an assessment of existing variation in outcomes with neurohormonal therapy, by age,
26 will define the scope of the issue and the potential for improvement. Secondly, identification of the patient-level
27 characteristics associated with a high likelihood of benefit (or harm) from neurohormonal therapy among elderly HFrEF
28 patients will enable improved clinical care and the refinement of current quality metrics. Finally, a qualitative assessment
29 of elderly HFrEF patient priorities will lay the foundation for future research to develop the next generation of quality
30 metrics that incorporate patient preferences.
项目总结/文摘
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Lauren Gray Gilstrap其他文献
30-DAY, POST-HOSPITALIZATION OUTCOMES AMONG MEDICARE BENEFICIARIES WITH HFREF, 2008-2016
- DOI:
10.1016/s0735-1097(22)01248-7 - 发表时间:
2022-03-08 - 期刊:
- 影响因子:
- 作者:
Lauren Gray Gilstrap;Christopher Leggett;James O’Malley;Amber Barnato;Anna N.A. Tosteson;Jonathan Skinner - 通讯作者:
Jonathan Skinner
ONE-YEAR, P2Y12 ADHERENCE AFTER DRUG ELUTING STENT PLACEMENT AMONG MEDICARE BENEFICIARIES AND THE IMPACT OF “FIRST P2Y12” CHOICE
- DOI:
10.1016/s0735-1097(19)30703-x - 发表时间:
2019-03-12 - 期刊:
- 影响因子:
- 作者:
Lauren Gray Gilstrap;Micah Aaron;Robert Wild;Nancy Beaulieu;Michael Chernew;Mary Beth Landrum - 通讯作者:
Mary Beth Landrum
VARIATION BY AGE IN THE USE OF NEUROHORMONAL THERAPY IN ISCHEMIC HEART FAILURE WITH REDUCED EJECTION FRACTION
- DOI:
10.1016/s0735-1097(19)31308-7 - 发表时间:
2019-03-12 - 期刊:
- 影响因子:
- 作者:
Lauren Gray Gilstrap;Micah Aaron;Rob Wild;Nancy Beaulieu;Michael Chernew;Mary Beth Landrum - 通讯作者:
Mary Beth Landrum
GDTM USE AMONG MEDICARE BENEFICIARIES WITH HFREF, 2008-2015
- DOI:
10.1016/s0735-1097(22)01335-3 - 发表时间:
2022-03-08 - 期刊:
- 影响因子:
- 作者:
Lauren Gray Gilstrap;Christopher Leggett;James O’Malley;Amber Barnato;Anna N.A. Tosteson;Jonathan Skinner - 通讯作者:
Jonathan Skinner
RECURRENT MYOPERICARDITIS DUE TO AUTOIMMUNE POLYGLANDULAR SYNDROME 2
- DOI:
10.1016/s0735-1097(23)03944-x - 发表时间:
2023-03-07 - 期刊:
- 影响因子:
- 作者:
Christopher Lee;Sam Dow;Stanislav Henkin;Lauren Gray Gilstrap;Cynthia C. Taub - 通讯作者:
Cynthia C. Taub
Lauren Gray Gilstrap的其他文献
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{{ truncateString('Lauren Gray Gilstrap', 18)}}的其他基金
Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas
评估旨在改善农村地区临终关怀服务的政策解决方案
- 批准号:
10555012 - 财政年份:2023
- 资助金额:
$ 14.15万 - 项目类别:
The Impact of Quality Metrics on Outcomes Among Elderly Heart Failure Patients
质量指标对老年心力衰竭患者预后的影响
- 批准号:
10207751 - 财政年份:2018
- 资助金额:
$ 14.15万 - 项目类别: