PMID- 25440800
OWN - NLM
STAT- MEDLINE
DCOM- 20150124
LR  - 20220408
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 168
IP  - 5
DP  - 2014 Nov
TI  - Association between process quality measures for heart failure and mortality 
      among US veterans.
PG  - 713-20
LID - S0002-8703(14)00409-8 [pii]
LID - 10.1016/j.ahj.2014.06.024 [doi]
AB  - BACKGROUND: The few available studies of the Centers for Medicare and Medicaid 
      Services Hospital Inpatient Quality Reporting (IQR) care process indicators have 
      not linked receipt of recommended care processes in heart failure (HF) with lower 
      mortality. Because the Veterans Health Administration (VHA) also tracks hospital 
      inpatient quality reporting indicators, in addition to VHA-specific inpatient 
      (pneumococcal and influenza vaccination) and outpatient (angiotensin-converting 
      enzyme inhibitor [ACEI] or angiotensin receptor blocker [ARB] use for left 
      ventricular [LV] dysfunction and LV function documentation) care process 
      indicators, we examined the association between receipt of these care processes 
      and 30-day and 1-year mortality. METHODS: Retrospective study of 107,045 patients 
      with HF treated at 128 VHA hospitals between 2001 and 2007 and followed up 
      through 2008. We assessed the relationship between receipt of each HF care 
      process and death at 30 days (inpatients only) and 1 year (all patients), using 
      generalized estimating equations to adjust for clinical characteristics and 
      clustering within hospitals. RESULTS: Overall, inpatient/outpatient use of 
      ACEI/ARB and receipt of pneumococcal or influenza vaccinations were related to 
      lower risks of 30-day and/or 1-year mortality (adjusted odds ratios 0.51-0.77 for 
      vaccinations and 0.60-0.78 for ACEI/ARB use). Conversely, discharge instructions, 
      inpatient/outpatient LV function assessment, or weight instructions before 
      admission were either not related or related to a slightly increase in mortality. 
      Stratified analyses by various mortality risk subgroups did not reveal 
      discernable "dose-response" relationship between mortality risk stratification 
      and the association of care process and mortality. CONCLUSIONS: Receipt of care 
      processes related to recommended medications and vaccinations were associated 
      with lower 30-day and/or 1-year risk-adjusted mortality in patients with HF. 
      Receipt of care processes that assess patient counseling or chart documentation 
      was not related to lower mortality.
CI  - Published by Elsevier Inc.
FAU - Wu, Wen-Chih
AU  - Wu WC
AD  - Center of Innovation in Long-Term Services and Supports, Providence Veterans 
      Affairs Medical Center, Providence, RI; Department of Medicine, Alpert Medical 
      School of Brown University, Providence, RI; Medical Service, Providence Veterans 
      Affairs, Providence, RI. Electronic address: Wen-Chih.Wu@va.gov.
FAU - Jiang, Lan
AU  - Jiang L
AD  - Center of Innovation in Long-Term Services and Supports, Providence Veterans 
      Affairs Medical Center, Providence, RI.
FAU - Friedmann, Peter D
AU  - Friedmann PD
AD  - Center of Innovation in Long-Term Services and Supports, Providence Veterans 
      Affairs Medical Center, Providence, RI; Department of Medicine, Alpert Medical 
      School of Brown University, Providence, RI; Department of Community Health, Brown 
      University, Providence, RI.
FAU - Trivedi, Amal
AU  - Trivedi A
AD  - Center of Innovation in Long-Term Services and Supports, Providence Veterans 
      Affairs Medical Center, Providence, RI; Department of Community Health, Brown 
      University, Providence, RI; Medical Service, Providence Veterans Affairs, 
      Providence, RI.
LA  - eng
GR  - I01 HX000626/HX/HSRD VA/United States
PT  - Journal Article
DEP - 20140711
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Influenza Vaccines)
RN  - 0 (Pneumococcal Vaccines)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin Receptor Antagonists/*therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Female
MH  - Guideline Adherence/*statistics & numerical data
MH  - Heart Failure/mortality/*therapy
MH  - Hospital Mortality
MH  - Humans
MH  - Influenza Vaccines/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Outcome and Process Assessment, Health Care
MH  - Patient Education as Topic/statistics & numerical data
MH  - Pneumococcal Vaccines/*therapeutic use
MH  - *Practice Guidelines as Topic
MH  - Quality Indicators, Health Care
MH  - United States
MH  - United States Department of Veterans Affairs
MH  - Ventricular Dysfunction, Left/diagnosis
MH  - Ventricular Function, Left
MH  - *Veterans
PMC - PMC4911696
MID - NIHMS768646
EDAT- 2014/12/03 06:00
MHDA- 2015/01/27 06:00
PMCR- 2016/06/17
CRDT- 2014/12/03 06:00
PHST- 2013/10/04 00:00 [received]
PHST- 2014/06/21 00:00 [accepted]
PHST- 2014/12/03 06:00 [entrez]
PHST- 2014/12/03 06:00 [pubmed]
PHST- 2015/01/27 06:00 [medline]
PHST- 2016/06/17 00:00 [pmc-release]
AID - S0002-8703(14)00409-8 [pii]
AID - 10.1016/j.ahj.2014.06.024 [doi]
PST - ppublish
SO  - Am Heart J. 2014 Nov;168(5):713-20. doi: 10.1016/j.ahj.2014.06.024. Epub 2014 Jul 
      11.