PMID- 32148101 OWN - NLM STAT- MEDLINE DCOM- 20200826 LR - 20210310 IS - 1941-7705 (Electronic) IS - 1941-7713 (Print) IS - 1941-7713 (Linking) VI - 13 IP - 3 DP - 2020 Mar TI - Opportunities and Challenges of Claims-Based Quality Assessment: The Case of Postdischarge beta-Blocker Treatment in Patients With Heart Failure With Reduced Ejection Fraction. PG - e006180 LID - 10.1161/CIRCOUTCOMES.119.006180 [doi] AB - BACKGROUND: To combat the high cost and increasing burden of quality reporting, the Medicare Payment Advisory (MedPAC) has recommended using claims data wherever possible to measure clinical quality. In this article, we use a cohort of Medicare beneficiaries with heart failure with reduced ejection fraction and existing quality metrics to explore the impact of changes in quality metric methodology on measured quality performance, the association with patient outcomes, and hospital rankings. METHODS AND RESULTS: We used 100% Medicare Parts A and B and a random 40% sample of Part D from 2008 to 2015 to create (1) a cohort of 295 494 fee-for-service beneficiaries with >/=1 hospitalization for heart failure with reduced ejection fraction and (2) a cohort of 1079 hospitals with >/=11 heart failure with reduced ejection fraction admissions in 2014 and 2015. We used Part D data to calculate beta-blocker use after discharge and beta-blocker use over time. We then varied the quality metric methodologies to explore the impact on measured performance. We then used multivariable time-to-event analyses to explore the impact of metric methodology on the association between quality performance and patient outcomes and Kendall's Tau to describe impact of quality metric methodology on hospital rankings. We found that quality metric methodology had a significant impact on measured quality performance. The association between quality performance and readmissions was sensitive to changes in methodology but the association with 1-year mortality was not. Changes in quality metric methodology also had a substantial impact on hospital quality rankings. CONCLUSIONS: This article highlights how small changes in quality metric methodology can have a significant impact on measured quality performance, the association between quality performance and utilization-based outcomes, and hospital rankings. These findings highlight the need for standardized quality metric methodologies, better case-mix adjustment and cast further doubt on the use of utilization-based outcomes as quality metrics in chronic diseases. FAU - Gilstrap, Lauren AU - Gilstrap L AD - Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH (L.G., B.G.). AD - The Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH. AD - Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (L.G.). FAU - Skinner, Jonathan S AU - Skinner JS AD - The Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH. FAU - Gladders, Barbara AU - Gladders B AD - Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH (L.G., B.G.). FAU - O'Malley, A James AU - O'Malley AJ AD - The Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH. AD - Department of Biomedical Data Science (A.J.O.), Geisel School of Medicine at Dartmouth, Lebanon, NH. FAU - Barnato, Amber E AU - Barnato AE AD - The Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH. FAU - Tosteson, Anna N A AU - Tosteson ANA AD - The Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH. FAU - Austin, Andrea M AU - Austin AM AD - The Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH. LA - eng GR - K23 HL142835/HL/NHLBI NIH HHS/United States GR - P01 AG019783/AG/NIA NIH HHS/United States GR - P30 CA023108/CA/NCI NIH HHS/United States GR - UL1 TR001086/TR/NCATS NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20200309 PL - United States TA - Circ Cardiovasc Qual Outcomes JT - Circulation. Cardiovascular quality and outcomes JID - 101489148 RN - 0 (Adrenergic beta-Antagonists) SB - IM CIN - Circ Cardiovasc Qual Outcomes. 2020 Mar;13(3):e006455. PMID: 32148100 MH - *Administrative Claims, Healthcare MH - Adrenergic beta-Antagonists/adverse effects/*therapeutic use MH - Aged MH - Aged, 80 and over MH - Data Accuracy MH - Databases, Factual MH - Female MH - Heart Failure/diagnosis/*drug therapy/physiopathology MH - Humans MH - Male MH - Medicare/standards MH - Patient Discharge/*standards MH - Patient Readmission/standards MH - Quality Improvement/standards MH - Quality Indicators, Health Care/*standards MH - Risk Assessment MH - Risk Factors MH - *Stroke Volume MH - Time Factors MH - Treatment Outcome MH - United States MH - *Ventricular Function, Left PMC - PMC7189209 MID - NIHMS1552799 OTO - NOTNLM OT - chronic disease OT - fee-for-service OT - heart failure OT - medicare OT - mortality EDAT- 2020/03/10 06:00 MHDA- 2020/08/28 06:00 PMCR- 2021/03/09 CRDT- 2020/03/10 06:00 PHST- 2020/03/10 06:00 [entrez] PHST- 2020/03/10 06:00 [pubmed] PHST- 2020/08/28 06:00 [medline] PHST- 2021/03/09 00:00 [pmc-release] AID - 10.1161/CIRCOUTCOMES.119.006180 [doi] PST - ppublish SO - Circ Cardiovasc Qual Outcomes. 2020 Mar;13(3):e006180. doi: 10.1161/CIRCOUTCOMES.119.006180. Epub 2020 Mar 9.