Pitfalls in assessing the quality of care for patients with cardiovasculardisease

PURPOSE: There are no clinical performance measures for cardiovascular dise ases that span the continuum of hospital through postdischarge ambulatory c are. We tested the feasibility of developing and implementing such measures for patients with acute myocardial infarction, congestive heart failure, o r hypertension. SUBJECTS AND METHODS: After reviewing practice guidelines and the medical l iterature, we developed potential measures related to therapy, diagnostic e valuation, and communication. We tested the feasibility of implementing the selected measures for 518 patients with myocardial infarction, 396 with he art failure, and 601 with hypertension who were enrolled in four major U.S. managed care plans at six geographic sites, using data from administrative claims, medical records, and patient surveys. RESULTS: Difficulties in obtaining timely data and small numbers of cases a dversely affected measurement. We encountered 6- to 12-month delays, disagr eement between principal discharge diagnosis as coded in administrative and records data (for 9% of myocardial infarction and 21 % of heart failure pa tients), missing medical records (20% for both myocardial infarction and he art failure patients), and problems in identifying physicians accountable f or care. Low rates of performing key diagnostic tests (e.g., ejection fract ion) excluded many cases from measures of appropriate therapy that were con ditional on test results. Patient survey response rates were low. CONCLUSIONS: Constructing meaningful clinical performance measures is strai ghtforward, but implementing them on a large scale will require improved da ta systems. Lack of standardized data captured at the point of clinical car e and low rates of eligibility for key measures hamper measurement of quali ty of care. (C) 2001 by Excerpta Medica, Inc.