Heart Failure: Core

Measures

BIO 301: Pharmacology

What is a Core Measure?

Core measures are Joint Commission required measures that were established using evidence based practice. Over time, it demonstrated better patient health care outcomes.
They are National Quality Indicators

Derived largely from a set of quality indicators defined by the Centers for Medicare and Medicaid Services (CMS).
They have been shown to reduce the risk of complications, prevent recurrences and otherwise treat the majority of patients who come to a hospital for treatment of a condition or illness. Core Measures help hospitals improve the quality of patient care by focusing on the actual results of care.

Core Measures is a National Quality Initiative

Mandated by the Center for Medicare & Medicaid Services (CMS) and The Joint Commission (TJC) to monitor specific hospital clinical processes and how well hospitals provide recommended care Evidence based best practice
All major payers moving toward using Core Measure results to benchmark & for contract negotiations

Basis for Medicare Pay for Performance/Value Based Purchasing

As of 2013, also the basis for Physician reimbursement
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What does each Core Measure stand for?

35 Core Measures 4 categories (acute myocardial infarction, pneumonia, congestive heart failure, and surgical care improvement project).
Under each category, key actions are listed that represent the most widely accepted, research-based care process for appropriate care in that category.

Core Measures
Hospital Inpatient
Acute Myocardial Infarction (AMI) Heart Failure (HF) Pneumonia (PN) Surgical Care Improvement Project (SCIP) Emergency Department (ED) Throughput Measure-Admitted Patients Global Immunization

Hospital Out-patient (HOP)

Emergency Department (ED) Throughput Measures -Discharged Patients Surgery AMI/Chest Pain
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Heart Failure Indicators

Discharge Instructions documented o Diet, activity, weight management, what to do if symptoms worsen, medications, physician follow up appointment Evaluation of Left Ventricular Systolic (LVS) Function ACEI or ARB for Left Ventricular Systolic Dysfunction (LVSD)
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Heart Failure
Indicator Documentation Requirements

Discharge Instructions (diet,

activity, weight monitoring, what to do if symptoms worsen, medications, physician follow up)

Provided by Nursing and on MD Discharge instructions. National emphasis as part of readmission reduction Even if an echo is not needed, some reference to past echo or narrative description of LV function MUST be documented in current record

Evaluation of LVS Function

ACEI or ARB for LVSD

If not prescribed, reason MUST be documented appropriate data field Contraindication to one not necessarily contraindication for the other; both need to be referenced
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