Publications [#172852] of Lesley H Curtis

Papers Published

1. ME Patterson, AF Hernandez, BG Hammill, GC Fonarow, ED Peterson, KA Schulman, LH Curtis, Process of care performance measures and long-term outcomes in patients hospitalized with heart failure., Medical care, vol. 48 no. 3 (March, 2010), pp. 210-6, ISSN 1537-1948 [doi]
   (last updated on 2013/07/01)

   Abstract:
   BACKGROUND: Recent efforts to improve care for patients hospitalized with heart failure have focused on process-based performance measures. Data supporting the link between current process measures and patient outcomes are sparse. OBJECTIVE: To examine the relationship between adherence to hospital-level process measures and long-term patient-level mortality and readmission. METHODS: Analysis of data from a national clinical registry linked to outcome data from the Centers for Medicare and Medicaid Services (CMS). METHODS: A total of 22,750 Medicare fee-for-service beneficiaries enrolled in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure between March 2003 and December 2004. METHODS: Mortality at 1 year; cardiovascular readmission at 1 year; and adherence to hospital-level process measures, including discharge instructions, assessment of left ventricular function, prescription of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge, prescription of beta-blockers at discharge, and smoking cessation counseling for eligible patients. RESULTS: Hospital conformity rates ranged from 52% to 86% across the 5 process measures. Unadjusted overall 1-year mortality and cardiovascular readmission rates were 33% and 40%, respectively. In covariate-adjusted analyses, the CMS composite score was not associated with 1-year mortality (hazard ratio, 1.00; 95% confidence interval, 0.98-1.03; P = 0.91) or readmission (hazard ratio, 1.01; 95% confidence interval, 0.99-1.04; P = 0.37). Current CMS process measures were not independently associated with mortality, though prescription of beta-blockers at discharge was independently associated with lower mortality (hazard ratio, 0.94; 95% confidence interval, 0.90-098; P = 0.004). CONCLUSIONS: Hospital process performance for heart failure as judged by current CMS measures is not associated with patient outcomes within 1 year of discharge, calling into question whether existing CMS metrics can accurately discriminate hospital quality of care for heart failure.

   Keywords:
   Aged • Aged, 80 and over • Cardiovascular Agents • Centers for Medicare and Medicaid Services (U.S.) • Female • Heart Failure • Hospital Administration • Humans • Insurance Claim Review • Male • Patient Compliance • Patient Readmission • Process Assessment (Health Care) • Quality Indicators, Health Care • Smoking Cessation • Treatment Outcome • United States • mortality • statistics & numerical data • statistics & numerical data* • therapeutic use • therapy*