Specifications Manual for Joint Commission National Quality Measures (v2019A)

Release Notes:
Measure Information Form
Version 2019A

Measure Information Form

Measure Set: Advanced Certification Heart Failure Outpatient (ACHFOP)

Set Measure ID: ACHFOP-04

Performance Measure Name: Hosptial Outpatient New York Heart Association (NYHA Classification Assessment)

Description: A baseline assessment of functional outcome utilizing the New York Heart Association (NYHA) classification documented at the time of the initial outpatient visit.

Rationale: Physician-assigned New York Heart Association (NYHA) class has been shown to be predictive of outcomes in heart failure including hospitalization and mortality (Holland et al., 2010). Classification involves the physician's subjective interpretation of patient symptoms and clinical data; therefore, variation in class assignment between different observers is common. To improve objectivity, the pairing of NYHA class with patient self-assessment of functional status has been recommended by some clinical studies (Coelho et al., 2005).

Treatment goals for heart failure patients include symptom relief and improved prognosis. Another major goal is to maximize function in activities of daily living and improve the quality of life within the limits imposed by the disease (Flynn et al., 2009).

Assessment activities consistent with clinical practice guidelines for a targeted population are an integral component of diseases-specific patient care. For Advanced Certification in Heart Failure, these activities should include an assessment of functional capacity (The Joint Commission's Comprehensive Certification Manual for Disease-Specific Care).

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients for whom a New York Heart Association (NYHA) Classification Assessment was documented at the time of the initial outpatient visit.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: All heart failure patients
Included Populations:
  • E/M Code for hospital outpatient encounter as defined in Appendix A, Table 2.0, and
  • An ICD-10-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1

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
  • Patients enrolled in a clinical trial

Data Elements:

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.

Selected References:
  • Coelho R, Ramos S, Prata J, Bettencourt P, Ferreira A, Cerqueira-Gomes M. Heart failure and health related quality of life. Clin Pract Epidemiol Ment Health. 2005;1:19.
  • Flynn KE, Lin L, Ellis SJ, Russell SD, Spertus JA, Whellan DJ, Piña IL, Fine LJ, Schulman KA, Weinfurt KP; HF-ACTION Investigators. Outcomes, health policy, and managed care: relationships between patient-reported outcome measures and clinical measures in outpatients with heart failure. Am Heart J. 2009;158(4 Suppl):S64-71
  • Hobbs FD, Kenkre JE, Roalfe AK, Davis RC, Hare R, Davies MK. Impact of heart failure and left ventricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. Eur Heart J. 2002;23(23):1867-1876.
  • Holland R, Rechel B, Stepien K, Harvey I, Brooksby I. Patients' self-assessed functional status in heart failure by New York Heart Association class: a prognostic predictor of hospitalizations, quality of life and death. J Card Fail. 2010 Feb;16(2):150-156.
  • Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, Haass M. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart. 2002;87(3):235-241.
  • The Joint Commission. The Joint Commission's 2019 Comprehensive Certification Manual for Disease-Specific Care: Advanced Certification in Heart Failure Addendum. Oakbrook Terrace, IL: Author. 2019.
  • Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128:e240–e327.

Measure Algorithm:

Measure Information Form ACHFOP-04
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Specifications Manual for Joint Commission National Quality Measures (v2019A)
Discharges 07-01-19 (3Q19) through 12-31-19 (4Q19)

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