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 (ACHF)

Set Measure ID: ACHF-05

Performance Measure Name: Advance Directive Executed

Description: Patients who have documentation in the medical record that an advance directive was executed.

Rationale: Heart failure is a progressive, debilitating disease which carries with it a poor prognosis over time and high mortality rate. Physicians should acknowledge the life-threatening nature of the disease and discuss with patients and/or their caregivers prognosis, quality of life, pharmacologic and device therapies, self-management, and supportive care options (HFSA, 2010).

According to Heffner and Barbieri, most patients at fourteen cardiac rehabilitation programs across the United States, presumed the need for life-support at some point in the future and wanted to make their own decisions about end-of-life care. Most of the patients were aware of advance directives, desired more information, and preferred to get more information from their lawyers, families, physicians, or cardiac rehabilitation programs (Perkins, 2000). Despite this receptiveness, only 15% of patients had discussed advance directives with their physicians, and 10% had confidence that their physicians understood their wishes (Heffner and Barbieri, 2000).

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients who have documentation in the medical record that an advance directive was executed.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: All heart failure patients.
Included Populations:
  • Discharges with ICD-10-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and
  • Patients who left against medical advice (AMA)
  • Patients enrolled in a Clinical Trial

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 who have a Length of Stay Greater than 120 days
  • Patients with Comfort Measures Only documented
  • Patients discharged to another hospital
  • Patients discharged to home for hospice care
  • Patients discharged to a health care facility for hospice care
  • Patients who expire

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:
  • Anderson R, Joy S, Carkido A, Anthony S, Smyntek d, Perrine S, Puet TA, Butler ET. Development of a Congestive Heart Failure Protocol in a Rehabilitation Setting. Rehab Nursing 2010;35(1);3-7;30.
  • Hefner JE, Barberi C. End-of-life care preferences of patients enrolled in cardiovascular rehabilitation programs. Chest. 2000;117(5);1474-1481.
  • Kass-Bartelmes BL, Hughes R. Advance Care Planning Preferences for care at the end of life. J Pain Palliat Care Pharmacother. 2004;18(1):87-109.
  • Perkins HS. Time to move advance care planning beyond advance directives. Chest. 2000;117(5);128-1231.
  • Wilkinson A. Living with Advanced Congestive Heart Failure: A Guide for Family Caregivers. The Washington Home Center for Palliative Care Studies (A Division of the RAND Corporation). Nov 2002.
  • 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 ACHF-05
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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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