Perspective:

The following are points to remember about the 2011 Performance Measures for Adults With Heart Failure (HF):

1. These updated performance measures pertain to diagnosis, treatment, and outcomes of HF patients with the goal to improve care. This set is comprised of nine measures, including three new measures and six revised measures, of which three measures are designated as quality metrics.
2. Two measures apply to care in both the inpatient and outpatient setting, five measures address care in the outpatient setting only, and two measures address care in the inpatient setting only. Also, eight earlier measures have been retired.
3. Updated measures are as follows:
1. Left ventricular ejection fraction (LVEF): Both outpatient and inpatient measure. A qualitative description of LVEF equivalents is also included.
2. Symptom and activity assessment: Outpatient measure. This is also a quality metric.
3. Symptom management (the symptom management measure includes documentation of a care plan to attempt to alleviate ongoing symptoms by changing medication doses, adding new medications, considering device therapy, or referring patients to specialty HF teams for advanced care): Outpatient measure. This is also a quality metric and a new measure. This test measure is designated for use in internal quality improvement programs only. It is not appropriate for any other use, for example, pay for performance, physician ranking, or public reporting programs.
4. Patient self-care education (self-care education on ≥3 elements of education during ≥1 visit within a 12-month period): Outpatient measure. This has been changed to a quality metric. This test measure is designated for use in internal quality improvement programs only. It is not appropriate for any other use, for example, pay for performance, physician ranking, or public reporting programs.
5. Beta-blocker treatment for patients with LV systolic dysfunction when EF <40% (with bisoprolol, carvedilol, or sustained-release metoprolol succinate either within a 12-month period when seen in the outpatient setting or at hospital discharge): Outpatient and inpatient measure. This is a new measure for inpatients. This document requires use of specific beta-blockers because the beta-blocker is not a class effect.
6. Angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) treatment for patients with LV systolic dysfunction when EF <40% either within a 12-month period when seen in the outpatient setting or at hospital discharge: Outpatient and inpatient measure.
7. Counseling for implantable cardioverter-defibrillator (ICD) when current LVEF ≤35% despite ACE inhibitor/ARB and beta-blocker treatment for at least 3 months, who were counseled about ICD implantation as a treatment option for the prophylaxis of sudden death: Outpatient measure. This is also a new quality metric. This test measure is designated for use in internal quality improvement programs only. It is not appropriate for any other use, for example, pay for performance, physician ranking, or public reporting programs.
8. Post-discharge outpatient appointment for HF patients (percentage of patients, regardless of age, discharged from an inpatient facility to ambulatory care or home health care with a principal discharge diagnosis of HF for whom a follow-up appointment was scheduled and documented, including location, date, and time for a follow-up office visit or home health care visit): Inpatient measure. This is a new measure.
4. The eight retired measures include:
1. Anticoagulant at discharge for HF patients with atrial fibrillation: Retired because a similar measure has been developed for the broader population.
2. Discharge instructions: Retired because a new measure, which is patient education on self-care is considered to have a high impact on mortality and readmission.
3. Adult smoking cessation advice/counseling for inpatient: Retired because a similar measure has been developed for the broader population.
4. Initial laboratory tests: Retired because it is standard of care and performance is high and not expected to impact outcomes.
5. Weight measurement: Retired because it is standard of care and performance is high and not expected to impact outcomes. Also, the evidence is poor.
6. Measurement of blood pressure: Retired because it is standard of care and performance is high and not expected to impact outcomes. Also, the evidence is poor.
7. Assessment of clinical signs of volume overload: Retired because supportive evidence is poor and does not meet rigor required for performance measurement.
8. Warfarin therapy for atrial fibrillation patients: Retired because a similar measure has been developed for the broader population with atrial fibrillation.
5. Two measures, including the “Overuse of Echocardiography” measure from the outpatient set and “End-of-Life Care Plan” measure from the inpatient set were developed by the writing committee, but were discarded from the HF performance measure set after the peer review and public comment periods. These measures, although potentially of value for improving patterns of care, were not believed to have been tested in clinical situations to ensure their reliability and validity.