Administrative Memos

200108

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jun 18, 2001
SUBJECT: Medicare Project: Congestive Heart Failure
IPRO CONTACTS:

Charles Stimler, M.D., M.P.H., Clinical Coordinator, ext 634, Monte Malach, M.D., F.A.C.C., M.A.C.P., Medical Director/Clinical Coordinator, ext 634 and Barbara Shields, R.N., C.P.H.Q., Upstate Director, Improvement Strategies

Enclosed please find a statewide report on "New York State Congestive Heart Failure - Quality Improvement Report, Middle Tier Hospitals". This report summarizes progress made on the CHF quality indicators over the past 9 months among middle volume hospitals in New York State. A major goal of this quality improvement project is to increase utilization of angiotensin converting enzyme inhibitors (ACEI) in eligible Medicare patients (those with left ventricular systolic dysfunction and heart failure) without contraindications. In addition, this project is attempting to improve the processes of ejection fraction measurement, community beta-blocker usage, weight monitoring, smoking cessation education, and discharge planning for patients with congestive heart failure (CHF).

IPRO has been working with physicians, providers and other health care personnel throughout New York State since 1996 on improving the detection of left ventricular systolic dysfunction (LVSD) and the clinical management of CHF.

Findings of this study indicate opportunities to improve. Over one quarter of patients (28.3%) with CHF not admitted on ACEI but who were eligible candidates for ACEI did not receive ACEI prior to discharge. The rate of use of beta-blockers prior to admission (a marker for the extent of use in the community) which is now recommended for most CHF patients with LVSD without contraindications is at about 35%. Although this showed an increase from a baseline of 30.5% much room for further improvement still exists. IPRO believes that the results of this study will be of great interest for all clinicians who treat patients with CHF.