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Complete Summary


TITLE

Heart failure in adults: percentage of adult patients with a primary diagnosis of heart failure who have used tobacco anytime during the year prior to hospital arrival and who are given smoking cessation advice or counseling during the hospital stay or at discharge.

SOURCE(S)

  • Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Aug. 119 p. [217 references]

Measure Domain

PRIMARY MEASURE DOMAIN

SECONDARY MEASURE DOMAIN

Does not apply to this measure

Brief Abstract

DESCRIPTION

This measure is used to assess the percentage of adult patients with a primary diagnosis of heart failure who have used tobacco anytime during the year prior to hospital arrival and who are given smoking cessation advice or counseling during the hospital stay or at discharge.

RATIONALE

The priority aim addressed by this measure is to improve care of adult heart failure patients by assuring comprehensive patient education and follow-up care.

PRIMARY CLINICAL COMPONENT

Heart failure; smoking cessation advice or counseling

DENOMINATOR DESCRIPTION

Number of adult patients with a primary diagnosis of heart failure who have used tobacco anytime during the year prior to hospital arrival (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

NUMERATOR DESCRIPTION

Number of adult patients with a primary diagnosis of heart failure who have used tobacco anytime during the year prior to hospital arrival and who are given smoking cessation advice or counseling during the hospital stay or at discharge

Evidence Supporting the Measure

EVIDENCE SUPPORTING THE CRITERION OF QUALITY

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

NATIONAL GUIDELINE CLEARINGHOUSE LINK

Evidence Supporting Need for the Measure

NEED FOR THE MEASURE

Unspecified

State of Use of the Measure

STATE OF USE

Current routine use

CURRENT USE

Internal quality improvement

Application of Measure in its Current Use

CARE SETTING

Hospitals

PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

TARGET POPULATION AGE

Age greater than or equal to 18 years

TARGET POPULATION GENDER

Either male or female

STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

Characteristics of the Primary Clinical Component

INCIDENCE/PREVALENCE

Heart failure is a major health problem in the United States, and the incidence of the disease is projected to increase. It was the most frequent diagnosis of Medicare patients discharged from the hospital in 2001. There are an estimated 5 million individuals currently diagnosed with heart failure, 550,000 new cases diagnosed annually, and 1 million people hospitalized annually (including readmission rates of 30 to 60%).

EVIDENCE FOR INCIDENCE/PREVALENCE

  • Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Aug. 119 p. [217 references]

ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

BURDEN OF ILLNESS

There are over 260,000 annual deaths from heart failure. From 1979 to 2000 heart failure death rates have increased 148% and hospital discharges have increased 165%. The prognosis of patients with a new diagnosis of heart failure is poor. Senni et al. (1998) noted survival to be 86% at 3 months, 76% at one year, and only 35% at 5 years.

EVIDENCE FOR BURDEN OF ILLNESS

UTILIZATION

See the "Incidence/Prevalence" field.

COSTS

Unspecified

Institute of Medicine National Healthcare Quality Report Categories

IOM CARE NEED

Living with Illness

IOM DOMAIN

Effectiveness
Patient-centeredness

Data Collection for the Measure

CASE FINDING

Users of care only

DESCRIPTION OF CASE FINDING

Adult patients with a primary diagnosis of heart failure who have used tobacco anytime during the year prior to hospital arrival and who are discharged alive.

The time of assessment is at hospital discharge. Monthly data will be submitted quarterly.

The minimum sample size is 20 patients per month.

DENOMINATOR SAMPLING FRAME

Patients associated with provider

DENOMINATOR INCLUSIONS/EXCLUSIONS

Inclusions
Number of adult patients with a primary diagnosis of heart failure* who have used tobacco anytime during the year prior to hospital arrival**.

*International Classification of Diseases, Ninth Revision (ICD-9) codes: 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9. (Refer to the table, "Descriptions of ICD-9 Codes," in the original measure documentation for code descriptions.)

**Tobacco user is defined as someone who has smoked tobacco any time during the year prior to hospitalization.

Exclusions

  • Patients who are less than 18 years of age
  • Patients who died prior to discharge
  • Patients who were transferred to another hospital
  • Patients who left against medical advice
  • Patients discharged to hospice

RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the numerator

DENOMINATOR (INDEX) EVENT

Clinical Condition
Institutionalization

DENOMINATOR TIME WINDOW

Time window is a single point in time

NUMERATOR INCLUSIONS/EXCLUSIONS

Inclusions
Number of adult patients with a primary diagnosis of heart failure who have used tobacco anytime during the year prior to hospital arrival and who are given smoking cessation advice or counseling during the hospital stay or at discharge

Exclusions
Unspecified

MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

NUMERATOR TIME WINDOW

Institutionalization

DATA SOURCE

Administrative data
Medical record

LEVEL OF DETERMINATION OF QUALITY

Individual Case

PRE-EXISTING INSTRUMENT USED

Unspecified

Computation of the Measure

SCORING

Rate

INTERPRETATION OF SCORE

Better quality is associated with a higher score

ALLOWANCE FOR PATIENT FACTORS

Unspecified

STANDARD OF COMPARISON

Internal time comparison

Evaluation of Measure Properties

EXTENT OF MEASURE TESTING

Unspecified

Identifying Information

ORIGINAL TITLE

Percentage of adult patients with a primary diagnosis of heart failure who have used tobacco anytime during the year prior to hospital arrival and who are given smoking cessation advice or counseling during the hospital stay or at discharge.

MEASURE COLLECTION

DEVELOPER

Institute for Clinical Systems Improvement

FUNDING SOURCE(S)

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne, and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Work Group Members: Stephen Kopecky, MD (Work Group Leader) (Mayo Clinic) (Cardiology); Rufino Festin, MD (Park Nicollet Health Services) (Cardiology); Peter Smars, MD (Mayo Clinic) (Emergency Medicine); Mohammad T. Fareed, MD (Avera Health) (Family practice); Ashok Ojha, MD (Hutchinson Medical Center) (Internal Medicine); Mary Jo Macklem, RN (Park Nicollet Health Services) (Nursing); Joshua E. Breeding, PharmD, BCPS (Fairview University Medical Center) (Pharmacy); Robert Straka, PharmD (University of Minnesota Physicians) (Pharmacy); Angela Turner, Pa-C (Park Nicollet Health Services) (Physician Assistant); Penny Fredrickson (Institute for Clinical Systems Improvement) (Measurement Advisor); Ann-Marie Evenson, BS, RHIT (Institute for Clinical Systems Improvement) (Facilitator)

FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

ADAPTATION

Measure was not adapted from another source.

RELEASE DATE

2006 Aug

REVISION DATE

2007 Aug

MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Aug. 116 p.

SOURCE(S)

  • Institute for Clinical Systems Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Aug. 119 p. [217 references]

MEASURE AVAILABILITY

NQMC STATUS

This NQMC summary was completed by ECRI on November 24, 2006. This NQMC summary was updated by ECRI Institute on December 16, 2007.

COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.

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