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Influence of a Performance-Improvement Initiative on Quality of Care for Patients Hospitalized With Heart FailureResults of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF)
Gregg C. Fonarow, MD;
William T. Abraham, MD;
Nancy M. Albert, RN, PhD;
Wendy Gattis Stough, PharmD;
Mihai Gheorghiade, MD;
Barry H. Greenberg, MD;
Christopher M. O’Connor, MD;
Karen Pieper, MS;
Jie Lena Sun, MS;
Clyde W. Yancy, MD;
James B. Young, MD; for the OPTIMIZE-HF Investigators and Hospitals
Arch Intern Med. 2007;167(14):1493-1502.
Background Despite evidence-based national guidelines for optimal treatment of heart failure (HF), the quality of care remains inadequate. We sought to evaluate the effect of a national hospital-based initiative on quality of care in patients hospitalized with HF.
Methods Two hundred fifty-nine US hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) submitted data on 48 612 patients with HF from March 1, 2003, through December 31, 2004. Admission, hospital, discharge care, and outcomes data were collected using a Web-based registry that provided real-time feedback on performance measures benchmarked to other hospitals. Process-of-care improvement tools, including evidence-based best-practice algorithms and customizable admission and discharge sets, were provided.
Results Provision of complete discharge instructions and smoking-cessation counseling increased significantly (from 46.8%-66.5% and 48.2%-75.6%, respectively; P < .001 for both). Left ventricular function assessment started at a high rate (89.3%) and improved to 92.1% (P < .001). Angiotensin-converting enzyme inhibitors were prescribed at discharge to 75.8% of eligible patients, which did not improve during the 2-year study. There were trends for reduction of in-hospital mortality, postdischarge death, and combined postdischarge death and rehospitalization and a significant reduction in mean length of stay. Use of preprinted admission order sets and/or discharge checklists increased from 35.6% to 54.1% and was associated with an increase in the use of evidence-based therapies and lower risk-adjusted in-hospital mortality.
Conclusions Participation in OPTIMIZE-HF was associated with an increase in use of evidence-based therapy, adherence to performance measures, and shorter lengths of stay in patients hospitalized with HF. Increased use of process-of-care improvement tools was associated with further improvements in quality of care.
Trial Registration clinicaltrials.gov Identifier NCT00344513.
Author Affiliations: Departments of Medicine, University of California–Los Angeles Medical Center (Dr Fonarow), Duke University Medical Center, Durham, North Carolina (Dr Gattis Stough), University of California–San Diego Medical Center (Dr Greenberg), and The University of Texas Southwestern Medical Center, Dallas (Dr Yancy); Divisions of Cardiology, The Ohio State University, Columbus (Dr Abraham), Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Gheorghiade), and Duke University Medical Center/Duke Clinical Research Institute, Durham (Dr O’Connor); George M. and Linda H. Kaufman Center for Heart Failure (Dr Albert) and Department of Cardiovascular Medicine, Heart Failure Section (Dr Young), Cleveland Clinic Foundation, Cleveland, Ohio; Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, North Carolina (Dr Gattis Stough); and Duke Clinical Research Institute, Durham (Mss Pieper and Sun). Dr Yancy is now with Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas.
Group Information: A list of the OPTIMIZE-HF hospitals and investigators was published in JAMA. 2007;297(1):68-69.
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