Adherence to Heart Failure Quality-of-Care Indicators in US Hospitals

BACKGROUND: Quality-of-care indicators have been developed for patients hospitalized with heart failure. However, little is known about current rates of conformity with these indicators or their variability across hospitals. METHODS: Data from 81 142 admissions occurring between July 1, 2002, and December 31, 2003, at 223 academic and non-academic hospitals in the United States participating in the Acute Decompensated Heart Failure National Registry (ADHERE) were analyzed. Rates of conformity with the 4 Joint Commission on Accreditation of Healthcare Organizations core performance measures--discharge instructions (HF-1), assessment of left ventricular function (HF-2), use of angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction (HF-3), and smoking cessation counseling (HF-4)--as well as length of stay and in-hospital mortality rates were computed. RESULTS: Across all hospitals, the median rates of conformity with HF-1, HF-2, HF-3, and HF-4 were 24.0%, 86.2%, 72.0%, and 43.2%, respectively. Rates of conformity at individual hospitals varied from 0% to 100%, with statistically significant differences between academic and non-academic hospitals. Statistically significant positive independent predictors of overall conformity included the prevalence of comorbidities and the use of more intense pharmacologic management. Median hospital length of stay varied from 2.3 to 9.5 days, and in-hospital mortality varied from 0% to 11.1%. CONCLUSIONS: Among hospitals providing care for patients with heart failure, there is significant individual variability in conformity to quality-of-care indicators and clinical outcomes and a substantial gap in overall performance. Establishing educational initiatives and quality improvement systems to reduce this variability and eliminate this gap would be expected to substantially improve the care of these patients.