Release Notes:
Measure Information Form
Version 2010B
**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**Measure Information Form
Measure Set: Heart Failure (HF)
Set Measure ID: HF-1
Performance Measure Name: Discharge Instructions
Description: Heart failure patients discharged home with written instructions or educational material given to patient or caregiver at discharge or during the hospital stay addressing all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen.
Rationale: Patient non-compliance with diet and medications is an important reason for changes in clinical status. Health care professionals should ensure that patients and their families understand their dietary restrictions, activity recommendations, prescribed medication regimen, and the signs and symptoms of worsening heart failure. National guidelines strongly support the role of patient education (Hunt, 2005). Despite this recommendation, comprehensive discharge instructions are rarely provided to eligible older patients hospitalized with heart failure (CMS National Heart Failure Project baseline data).
Type of Measure: Process
Improvement Noted As: Increase in the rate
Numerator Statement: Heart failure patients with documentation that they or their caregivers were given written discharge instructions or other educational material addressing all of the following:
- activity level
- diet
- discharge medications
- follow-up appointment
- weight monitoring
- what to do if symptoms worsen
Included Populations: Not applicable
Excluded Populations: None
Data Elements:
Denominator Statement: Heart failure patients discharged home
Included Populations:
Discharges with:
- An ICD-9-CM Principal Diagnosis Code for heart failure as defined in Appendix A, Table 2.1
AND
- A discharge to home or home care
Excluded Populations:
- Patients who had a left ventricular assistive device (LVAD) or heart transplant procedure during hospital stay (ICD-9-CM 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 >120 days
- Patients enrolled in clinical trials
- Patients with Comfort Measures Only documented
Data Elements:
Continuous Variable Statement:
Included Populations:
Excluded Populations:
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-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.
Measure Analysis Suggestions: The data elements for each of the six discharge instruction elements provide the opportunity to assess each component individually. However, completion of all six instruction categories is required for this composite measure.
Sampling: Yes. For additional information see the Sampling Section.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
Selected References:
- Bonow RO, Bennett S, Casey DE, Ganiats TG, Hlatky MA, Konstam MA, Lambrew CT, Normand ST, Piña IL, Radford MJ, Smith AL, Stevenson L. ACC/AHA Clinical Performance Measures for Adults With Chronic Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Heart Failure Clinical Performance Measures). J Am Coll Cardiol 2005;46:1144–78. Available at http://www.acc.org and http://www.americanheart.org.
- Heart Failure Society of America. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2006 Feb;12(1):e1-2.
- Hunt SA. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005; 46(6):e1-82.
Measure Algorithm:
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