Enhancing quality of heart failure care in managed Medicare and Medicaid in North Carolina: Results of the North Carolina Achieving Cardiac Excellence (NC ACE) Project - 21/08/11
, Mark W. Massing, MD, PhD c, Alain G. Bertoni, MD, MPH a, b, Jennifer Davis, BSPH c, Walter T. Ambrosius, PhD a, Jill McArdle, RN, BSN, MSPH c, Vanessa Duren-Winfield, MS a, Carla A. Sueta, MD, PhD, FACC c, Janet B. Croft, PhD dThis project was supported by a cooperative agreement from the Centers for Disease Control and Prevention and the Association of Teachers of Preventive Medicine.
Résumé |
Objectives |
To evaluate an intervention to improve the quality of care of patients with heart failure in managed Medicare and Medicaid plans in North Carolina.
Background |
Utilization of angiotensin-converting enzyme inhibitors (ACE-I) and β-adrenergic receptor blockers (BB) in heart failure (HF) patients remains suboptimal despite evidence-based guidelines supporting their use.
Methods |
Managed care plans identified adult patients with HF during 2000 (preintervention) and from July 1, 2001, through June 30, 2002 (postintervention). Outpatient medical records were reviewed to obtain data regarding type of heart failure, demographics, comorbidities, and therapies. The intervention consisted of guideline summary dissemination, performance audit with feedback, patient-specific chart reminders, and patient activation mailings.
Results |
We sampled 1613 patients from 5 plans during the preintervention period and 1528 patients during the postintervention period. Assessment of left ventricular function (LVF) increased from 88.2% to 92.5% of patients (P < .0001). Among patients with moderate to severe left ventricular systolic dysfunction, there was no substantive change in treatment with ACE-I or vasodilators, whereas, appropriate treatment with BB increased from 48.3% (with another 11.9% with documented contraindications) to 67.9% (with another 7.5% with documented contraindications). The quality gap decreased from 39.8% to 24.6% (P < .0001).
Conclusion |
LVF assessment improved despite high preintervention rates. Treatment rates with ACE-I and vasodilators remained high, but did not improve. Treatment rates with BB improved substantially translating into a significant public health benefit. Health-care payers should consider development of financial incentives to encourage collaborative quality improvement programs.
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| Disclaimer: The analyses upon which this publication is based were performed under Contract Number 500-02-NC03, entitled Utilization and Quality Control Peer Review Organization for the State of North Carolina, sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed. |
Vol 150 - N° 4
P. 717-724 - octobre 2005 Retour au numéro
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