Abstract 3003: Greater Improvement in Heart Failure Care Quality With a Performance Improvement Initiative is Largely Independent of Patient and Practice Characteristics
Background: Variations in the delivery of evidence-based care are often seen due to differences in geography, practice characteristics, patient (pt) variables and other factors. This study evaluates the association of such factors with the degree of improvement in adherence to evidence-based guidelines for treatment of heart failure (HF) among outpatient cardiology practices over a 24-month period.
Methods: IMPROVE HF is a prospective study of a performance improvement initiative for pts with diagnosed HF or prior MI and LVEF ≤35% receiving care at US outpatient cardiology practices. Data on pt characteristics and care practices on 8758 pts from 89 practices were collected by chart abstraction at baseline and again at 24 months. To quantify guideline adherence, 7 individual care metrics were assessed: use of ACE-I/ARB, beta blocker, aldosterone antagonist, anticoagulation for atrial fibrillation, CRT-P/CRT-D, ICD/CRT-D and HF education. A composite score defined as the percentage of all indicated metric interventions that were provided was assessed. Practice and pt characteristics predictive of composite score improvement were examined.
Results: Composite performance was 67.3% at baseline and improved to 77.1% at 24 months (P<0.001). The only practice characteristic predictive of improvement in a multivariate model was location in the south region. Of 56 pt characteristics examined only the presence of ischemic etiology of HF, higher serum sodium and lower BUN were predictive of improvement in composite scores.
Conclusions: In outpatient cardiology practices participating in IMPROVE HF there was substantial improvement in quality of care over 24 months. However, the improvement in care quality was largely not associated with specific pt and practice characteristics, suggesting these factors were not major determinates of the success of performance improvement and that specific process of care improvement strategies may have driven greater adherence.