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## Complete Summary

#### TITLE

Heart failure in adults: percentage of adult heart failure patients with
documentation that LVS function was evaluated or will be evaluated
(primary care and outpatient cardiology).

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Heart failure in
adults. Bloomington (MN): Institute for Clinical Systems Improvement
(ICSI); 2007 Aug. 119 p. \[217 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of adult heart failure
patients with documentation that left ventricular systolic (LVS)
function was evaluated or will be evaluated.

#### RATIONALE

The priority aim addressed by this measure is to improve the use of
diagnostic testing in order to identify and then appropriately treat
adult patients with heart failure.

#### PRIMARY CLINICAL COMPONENT

Heart failure; left ventricular systolic (LVS) function; two-dimensional
echocardiogram; Doppler flow studies; radionuclide ventriculography

#### DENOMINATOR DESCRIPTION

Number of adult heart failure patients with a clinic visit during the
month in question (see the related \"Denominator Inclusions/Exclusions\"
field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Number of adult heart failure patients with documentation that left
ventricular systolic (LVS) function was evaluated or will be evaluated
(see the related \"Numerator Inclusions/Exclusions\" field in the
Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Heart failure in
    adults.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=11531)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Heart failure is a major health problem in the United States, and the
incidence of the disease is projected to increase. It was the most
frequent diagnosis of Medicare patients discharged from the hospital in
2001. There are an estimated 5 million individuals currently diagnosed
with heart failure, 550,000 new cases diagnosed annually, and 1 million
people hospitalized annually (including readmission rates of 30 to 60%).

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Institute for Clinical Systems Improvement (ICSI). Heart failure in
adults. Bloomington (MN): Institute for Clinical Systems Improvement
(ICSI); 2007 Aug. 119 p. \[217 references\]

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

There are over 260,000 annual deaths from heart failure. From 1979 to
2000 heart failure death rates have increased 148% and hospital
discharges have increased 165%. The prognosis of patients with a new
diagnosis of heart failure is poor. Senni et al. (1998) noted survival
to be 86% at 3 months, 76% at one year, and only 35% at 5 years.

#### EVIDENCE FOR BURDEN OF ILLNESS

Institute for Clinical Systems Improvement (ICSI). Heart failure in
adults. Bloomington (MN): Institute for Clinical Systems Improvement
(ICSI); 2007 Aug. 119 p. \[217 references\]

Senni M, Tribouilloy CM, Rodeheffer RJ, Jacobsen SJ, Evans JM, Bailey
KR, Redfield MM. Congestive heart failure in the community: a study of
all incident cases in Olmsted County, Minnesota, in 1991.
Circulation1998 Nov 24;98(21):2282-9.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9826315)

#### UTILIZATION

See the \"Incidence/Prevalence\" field.

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Adult heart failure patients who had a clinic visit during the month in
question.

The measurement period is monthly. Monthly data will be submitted
quarterly. For the patients who are in the monthly sample, the data
cover the entire span of the patients\' primary care and outpatient
cardiology histories.

The minimum sample size is 20 patients per month.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of adult heart failure\* patients with a clinic visit\*\* during
the month in question

\*International Classification of Diseases, Ninth Revision (ICD-9)
codes: 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91,
404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31,
428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9. (Refer to the
table, \"Descriptions of ICD-9 Codes,\" in the original measure
documentation for code descriptions.)

\*\*The clinic visit is defined as an office visit with a physician,
nurse practitioner, or physician assistant. Education office visits may
include a visit with a nurse.

**Exclusions**\
Exclude visits for the purpose of testing or device checks only.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of adult heart failure patients with documentation that left
ventricular systolic (LVS) function\* was evaluated or will be evaluated

\*The most useful evaluation of left ventricular function is the
comprehensive two-dimensional echocardiogram coupled with Doppler flow
studies. Radionuclide ventriculography can also be performed to assess
left ventricular ejection fraction and volume. Description of left
ventricular systolic function may be quantitative (i.e., ejection
fraction) or qualitative (e.g., \"moderately depressed\" or visually
estimated ejection fraction).

**Exclusions**

-   Patients who are less than 18 years of age

-   Patients with reason(s) documented by a physician, nurse
    practitioner, or physician assistant for no LVS function evaluation

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of adult heart failure patients with documentation that LVS
function was evaluated or will be evaluated (primary care and outpatient
cardiology).

#### MEASURE COLLECTION

[Heart Failure in Adults
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=4466)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2006 Aug

#### REVISION DATE

2007 Aug

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Heart failure in adults. Bloomington (MN): Institute
for Clinical Systems Improvement (ICSI); 2006 Aug. 116 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Heart failure in
adults. Bloomington (MN): Institute for Clinical Systems Improvement
(ICSI); 2007 Aug. 119 p. \[217 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of adult heart failure patients
with documentation that LVS function was evaluated or will be evaluated
(primary care and outpatient cardiology),\" is published in \"Health
Care Guideline: Heart Failure in Adults.\" This document is available
from the [Institute for Clinical Systems Improvement (ICSI) Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail:
<icsi.info@icsi.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI on November 29, 2006. This NQMC
summary was updated by ECRI Institute on December 16, 2007.

#### COPYRIGHT STATEMENT

This NQMC summary (abstracted Institute for Clinical Systems Improvement
\[ICSI\] Measure) is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be
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All other copyright rights in the abstracted ICSI Measures are reserved
by the Institute for Clinical Systems Improvement, Inc. The Institute
for Clinical Systems Improvement, Inc. assumes no liability for any
adaptations or revisions or modifications made to the abstracts of the
ICSI Measures.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008