Heart Failure (HF)

Set Measures

Set Measure ID	Measure Short Name
HF-1	Discharge Instructions
HF-2	Evaluation of LVS Function
HF-3	ACEI or ARB for LVSD
HF-4	Adult Smoking Cessation Advice/Counseling

General Data Elements

Element Name	Collected For
Birthdate	All Records,
Discharge Date	All Records, (used in algorithm for AMI-1, AMI-6, PN-1, PN-3a, PN-3b, PN-5, PN-5b, PN-5c, PN-6, PN-6a, PN-6b, PN-7, PR-2, SCIP-Inf-4, SCIP-VTE-1, SCIP-VTE-2)
Discharge Status	All Records, (used in algorithm for AMI-1, AMI-2, AMI-3, AMI-4, AMI-5, AMI-6, AMI-9, AMI-T1a and AMI-T2 [CMS Optional Test Measures], CAC-3 [Joint Commission Test Measure], All HF Measures, All PN Measures, PR-2)
First Name	All Records, CMS Only,
Hispanic Ethnicity	All Records, CMS Only,
Hospital Patient Identifier	All Records, CMS Only, NOTE: Refer to the Hospital Clinical Data XML File Layout in the Transmission section of this manual.
Last Name	All Records, CMS Only,
Patient HIC#	All Records, CMS Only, Collected by CMS for patients with a Payment Source - Medicare who have a standard HIC number.
Physician 1	All Records, Optional for All Records, (CMS Optional Element)
Physician 2	All Records, Optional for All Records, (CMS Optional Element)
Point of Origin for Admission or Visit	All Records, (used in algorithm for AMI-1, AMI-6, AMI-7, AMI-7a, AMI-8, AMI-8a, AMI-9, PN-1, PN-3a, PN-5, PN-5b, PN-5c, PN-6, PN-6a, PN-6b
Postal Code	All Records, CMS Only,
Race	All Records, CMS Only,

Algorithm Output Data Elements

Element Name	Collected For
Measure Category Assignment	Joint Commission Only, Calculation, Transmission, Hospital Clinical Data File

Measure Set Specific Data Elements

Element Name	Collected For
ACEI Prescribed at Discharge	HF-3,
ARB Prescribed at Discharge	HF-3,
Adult Smoking Counseling	HF-4,
Adult Smoking History	HF-4,
Comfort Measures Only	HF-1, HF-2, HF-3, HF-4,
Contraindication to Both ACEI and ARB at Discharge	HF-3,
Discharge Instructions Address Activity	HF-1,
Discharge Instructions Address Diet	HF-1,
Discharge Instructions Address Follow-up	HF-1,
Discharge Instructions Address Medications	HF-1,
Discharge Instructions Address Symptoms Worsening	HF-1,
Discharge Instructions Address Weight Monitoring	HF-1,
LVF Assessment	HF-2,
LVSD	HF-3,

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Related Materials

	Document Name
	a. Table of Contents
	a1. Introduction to the manual
	a2. Acknowledgement and Conditions of Use
	a3. Using the Specifications Manual for National Hospital Inpatient Quality Measures
	b. Introduction to the Data Dictionary and lists of all data elements
	d. Missing and Invalid Data Chapter
	e. Population and Sampling Specifications
	j. National Hospital Quality Measure Data Transmission
	j1. Transmission Alphabetical Data Dictionary
	j2. Joint Commission and CMS Data Processing Flow
	z. Appendix A - ICD-9-CM Code Tables
	z. Appendix C - Medication Tables
	z. Appendix D - Glossary of Terms
	z. Appendix E - Measure Information Form and Flowchart Definitions
	z. Appendix G - Resources
	z. Appendix H - Miscellaneous Tables

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Heart Failure (HF) Initial Patient Population

Testing the release process with this temporary change.

The population of the HF measure set is identified using 4 data elements:

• ICD-9-CM Principal Diagnosis Code
• ICD-9-CM Principal Procedure Code
• ICD-9-CM Other Procedure Codes
• Admission Date
• Birthdate
• Discharge Date

Patients admitted to the hospital for inpatient acute care with an ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, no ICD-9-CM Principal or Other Procedure Code of Left Ventricular Assistive Device (LVAD) or Heart Transplant as defined in Appendix A, Table 2.2, a Patient Age (Admission Date – Birthdate) >= 18 years , and a Length of Stay (Discharge Date - Admission Date) <= 120 days are included in the HF Initial Patient Population and are eligible to be sampled.

• View the HF Initial Population Algorithm

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Sample Size Requirements

Hospitals that choose to sample have the option of sampling quarterly or sampling monthly. A hospital may choose to use a larger sample size than is required. Hospitals whose Initial Patient Population size is less than the minimum number of cases per quarter for the measure set cannot sample.

Regardless of the option used, hospital samples must be monitored to ensure that sampling procedures consistently produce statistically valid and useful data. Because the sample for a measure set will rarely be equal to the effective sample due to exclusions and contraindications, hospitals selecting sample cases MUST submit AT LEAST the minimum required sample size.

The following sample size tables for each option automatically build in the number of cases needed to obtain the required sample sizes. For information concerning how to perform sampling, refer to the Population and Sampling Specifications section in this manual.

Quarterly Sampling

Hospitals performing quarterly sampling for HF must ensure that its Initial Patient Population and effective sample size meet the following conditions:

• The effective sample size for HF is at least 35 cases per quarter; and
• The required sample size is at least 20% of the Initial Patient Population for the quarter.

Quarterly Sample Size
Based on Initial Patient Population for the HF Measure Set

Hospital's Measures
Average Quarterly Initial Patient Population “N”	Minimum Required Sample Size “n”
>= 1515	304
381 - 1514	20% of the Initial Patient Population
76 – 380	76
< 76	No sampling; 100% of the Initial Patient Population is required

Monthly Sampling

Hospitals performing monthly sampling for HF must ensure that its Initial Patient Population and effective sample size meet the following conditions:

• The effective sample size for HF is at least 12 cases per month; and
• The required sample size is at least 20% of the Initial Patient Population for the month.

Monthly Sample Size
Based on Initial Patient Population for the HF Measure Set

Hospital's Measures
Average Monthly Initial Patient Population “N”	Minimum Required Sample Size “n”
> 505	102
131 – 505	20% of the Initial Patient Population
26 – 130	26
< 26	No sampling; 100% of the Initial Patient Population is required

Sample Size Examples

• Quarterly sampling:
  • The HF Initial Patient Population size for a hospital has been 500 patients per quarter during the past year. The required quarterly sample size would be 100 (twenty percent of 500) heart failure patients per quarter -- as this number is smaller than the maximum condition (i.e., 304 cases) and larger than the minimum condition (i.e., 76 cases).
  • A hospital’s HF Initial Patient Population size is 1,482 patients during the third quarter. The required sample size is 20% of the patient population or 297 cases for the quarter (twenty percent of 1,482 equals 296.4 rounded to the next highest whole number = 297).
• Monthly sampling
  • A hospital’s HF Initial Patient Population size is 25 patients during March. Since this is less than the minimum condition (i.e., 26 cases), no sampling is allowed or 100% of the patient population of 25 cases is required.
  • A hospital’s HF Initial Patient Population size is 503 patients during July. The required sample size is 20% of the patient population or 101 cases for the month (twenty percent of 503 equals 100.6 rounded to the next highest whole number = 101).