Ask the Experts: Heart Failure
Dr. Philip D. Levy
ACC Accreditation Management Board Member
Assistant Professor of Emergency Medicine Associate
Director of Clinical Research Dept. of Emergency Medicine Wayne State University
A: Process measures such as the proportion of eligible patients who receive beneficial medications not tracked by CMS metrics (i.e., beta-blockers, aldosterone antagonists, and isorbide dinitrate/hydralazine), the proportion who receive and attend a post-discharge appointment, and the use of Palliative Medicine consultation for end-stage patients will be of tremendous value. Additionally, the inclusion of outcome measures beyond simple mortality or recidivism along with more extensive breakdown of the time frames for their occurrence will be important.
Q: Talk about the additional outcome measurements. Why are they so important?
A: They will provide insight into how processes of care affect things that actually matter to patients, payers and governmental agencies. Most process improvement initiatives stop at the process itself -- including outcome measures rounds out the picture telling what, beyond the ability to change an approach or intervention, the improvement initiative can achieve. In effect, it provides an assessment of return on quality telling institutions where they should put resources to better the health (not just the healthcare…) of their patients.
Q: So that phrase "return on quality" like return on investment will provide more than just data to react to … but also data to be proactive with? So, you won't just know "what happened" but you can drive "what you WANT to happen?"
Q: As a hospital CEO, or CFO, what does this HF tool allow you to do from an economic standpoint?
A: Figure out where to put your investment in people, clinics, etc., so that you can optimize management of your HF patients.
Q: And as a clinician, how would you rely on this tool? Or how would a nurse rely on it? There is so much data out there … how and why do you differentiate this information from all the other information you are getting?
A: This will provide an evidence-based approach to management of the HF patient and help you figure out which processes and procedures you should be putting into place. As the tool is a "living" thing, data will evolve over time helping you hone in on what are truly best practices.
Q: By "living" are you saying updated data regularly?
A: Yes. Data, criteria within the line items, references and shared practices will be updated as often as the science changes and at the minimum reviewed and enhanced on a quarterly basis.