Measure Information Form

Measure Set: Advanced Certification Heart Failure (ACHF)

Set Measure ID: ACHF-06

Performance Measure Name: Post-Discharge Evaluation for Heart Failure Patients

Description: Patients who receive a re-evaluation for symptoms worsening and treatment compliance by a program team member within 72 hours after inpatient 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 (2010), 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 2017 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.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

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

Included Populations: Not applicable
Excluded Populations: None
Data Elements:

Post-Discharge Evaluation Conducted Within 72 Hours

Denominator Statement: All heart failure patients discharged from a hospital inpatient setting to home or home care AND patients leaving against medical advice (AMA).

Included Populations:

Discharges with ICD-10-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and

A discharge to home, home care, or court/law enforcement

Patients who left against medical advice (AMA)

Excluded Populations:

Patients who had a left ventricular assistive device (LVAD) or heart transplant procedure during hospital stay (ICD-10-PCS procedure code for LVAD and heart transplant as defined in Appendix A, Table 2.2)

Patients less than 18 years of age

Patient who have a Length of Stay greater than 120 days

Patients with Comfort Measures Only documented

Patients enrolled in a Clinical Trial

Patients discharged to locations other than home, home care or law enforcement

Data Elements:

Admission Date

Birthdate

Clinical Trial

Comfort Measures Only

Discharge Date

Discharge Disposition

ICD-10-CM Principal Diagnosis Code

ICD-10-PCS Other Procedure Codes

ICD-10-PCS Principal Procedure Code

ICD-10-PCS Principal Procedure Date

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section.

Data Reported As: Aggregate rate generated from count data reported as a proportion. Aggregate rate generated from count data reported as a proportion

Selected References:

Hoyt RE, Bowling LS. Reducing Readmissions for Congestive Heart Failure. Am Fam Physician 2001;63(8):1593-1598.
Jha AK, Orav EJ, Epstein AM. Public Reporting of Discharge Planning and Rate of Readmissions. N Eng J Med 2009; 361(27):2637-2645.
The Joint Commission. The Joint Commission's 2017 Comprehensive Certification Manual for Disease-Specific Care: Advanced Certification in Heart Failure Addendum. Oakbrook Terrace, IL: Author. 2017.

Measure Algorithm:
ACHF-06_pg1

Measure Information Form ACHF-06

Specifications Manual for Joint Commission National Quality Measures (v2018B1)
Discharges 01-01-19 (1Q19) through 06-30-19 (2Q19)