Congestive Heart FailureSpectrum of heart failure in older patients: Results from the national heart failure project*,**,★
Section snippets
Methods
The National Heart Failure (NHF) project is an effort by the Centers for Medicare and Medicaid Services (CMS, formerly known as the Health Care Financing Administration) to improve the care of Medicare patients with HF across the United States. The NHF project includes baseline assessment of the quality of care for hospitalized patients with HF in each state, followed by efforts of peer review organizations to work with physicians and other providers in each state to improve performance. The
Results
Of the 39,477 charts available for data abstraction, at least 1 exclusion criterion was present in 1977 charts. The exclusions were as follows: 21 patients left the hospital prematurely against medical advice, 133 patients were transferred to other acute care facilities, 315 patients were receiving long-term renal dialysis, 1403 patients were admitted more than once during the sample period, 103 patients had no social security number, and 2 patients were of undetermined age. The current
Discussion
The present study is the largest analysis of patients hospitalized with HF in the United States. Unlike previous studies, the sample was not subject to restrictions of geography, sex, or socioeconomic status. It uniquely focused on patients ≥65 years old, the demographic group that comprises the preponderance of patients with HF in the United States. The study combined administrative level data with clinical data from chart review.
Several important observations emerge from the analysis. First,
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The analyses on which this publication is based were performed under Contract No. 500-99-C001 entitled “Utilization and Quality Control Peer Review Organization for the State of Colorado” sponsored by HCFA, Department of Health and Human Services.
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The content of the publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the United States government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by HCFA, which has encouraged identification of quality improvement projects from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experiences in engaging with issues presented are welcomed.
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Reprint requests: Edward P. Havranek, MD, Denver Health Medical Center #0960, 777 Bannock St, Denver, CO 80220.E-mail: [email protected]