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Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF).
Arch Intern Med. 2007 Jul 23; 167(14):1493-502.AI

Abstract

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.

Authors+Show Affiliations

Department of Medicine, University of California-Los Angeles Medical Center, 10833 LeConte Ave, Room 47-123 CHS, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17646603

Citation

Fonarow, Gregg C., et al. "Influence of a Performance-improvement Initiative On Quality of Care for Patients Hospitalized With Heart Failure: Results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF)." Archives of Internal Medicine, vol. 167, no. 14, 2007, pp. 1493-502.
Fonarow GC, Abraham WT, Albert NM, et al. Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med. 2007;167(14):1493-502.
Fonarow, G. C., Abraham, W. T., Albert, N. M., Gattis Stough, W., Gheorghiade, M., Greenberg, B. H., O'Connor, C. M., Pieper, K., Sun, J. L., Yancy, C. W., & Young, J. B. (2007). Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Archives of Internal Medicine, 167(14), 1493-502.
Fonarow GC, et al. Influence of a Performance-improvement Initiative On Quality of Care for Patients Hospitalized With Heart Failure: Results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med. 2007 Jul 23;167(14):1493-502. PubMed PMID: 17646603.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). AU - Fonarow,Gregg C, AU - Abraham,William T, AU - Albert,Nancy M, AU - Gattis Stough,Wendy, AU - Gheorghiade,Mihai, AU - Greenberg,Barry H, AU - O'Connor,Christopher M, AU - Pieper,Karen, AU - Sun,Jie Lena, AU - Yancy,Clyde W, AU - Young,James B, AU - ,, PY - 2007/7/25/pubmed PY - 2007/8/29/medline PY - 2007/7/25/entrez SP - 1493 EP - 502 JF - Archives of internal medicine JO - Arch Intern Med VL - 167 IS - 14 N2 - 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. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/17646603/Influence_of_a_performance_improvement_initiative_on_quality_of_care_for_patients_hospitalized_with_heart_failure:_results_of_the_Organized_Program_to_Initiate_Lifesaving_Treatment_in_Hospitalized_Patients_With_Heart_Failure__OPTIMIZE_HF__ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.167.14.1493 DB - PRIME DP - Unbound Medicine ER -