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Garcia Acevedo G, Ahmad A, Stall B, Mokhtarnia M, Lapp JM, Verma AA, Ebrahim J, Van Spall HGC, Razak F, Isenberg SR, Etchells E, Mak S, Steinberg L, Ko DT, Poon S, Quinn KL. International Comparison of Quality Indicators for Adults Hospitalized for Heart Failure: A Systematic Review. Circ Cardiovasc Qual Outcomes 2024; 17:e010629. [PMID: 39561228 DOI: 10.1161/circoutcomes.123.010629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 08/22/2024] [Indexed: 11/21/2024]
Abstract
BACKGROUND There is limited international agreement on defining care quality for the millions of people hospitalized with heart failure worldwide. Our objective was to compare and measure agreement across existing internationally published quality indicators (QIs) for the care of adults hospitalized for heart failure. METHODS Systematic review and evidence gap map of internationally published articles reporting on QIs for adults hospitalized for heart failure, using PubMed, MEDLINE, EMBASE, and TRIP from inception to July 18, 2022. Narrative synthesis and descriptive statistics characterized included articles and QIs using the Donabedian Framework of Structural, Process, and Outcomes. The methodological quality of QI sets was assessed using the Appraisal of Indicators through Research and Evaluation instrument. Agreement about QIs was defined as having at least 3 different cardiovascular societies recommend its use. An evidence gap map displayed each QI according to its clinically relevant category, methodological quality, and reporting articles. RESULTS Fourteen articles from 11 societies reported 75 unique QIs; 53 QIs were process, 16 were structural, and 7 were outcome measures. There was limited agreement on individual QIs across sets as a minority were recommended by ≥3 societies (12%; 9/75 QIs). The most common QIs included postdischarge follow-up (73%, 8/11 societies), specific pharmacotherapy (64%, 7/11 societies), patient education (45%, 5/11 societies), assessment of left ventricular ejection fraction (45%, 5/11 societies), 30-day readmission rate (45%, 5/11 societies), cardiac rehabilitation (36%, 4/11 societies), and multidisciplinary management (27%, 3/11 societies). CONCLUSIONS There was little agreement on defining high-quality care and limited agreement on measures including postdischarge follow-up, specific pharmacotherapies, patient education, assessment of left ventricular ejection fraction, 30-day readmission, cardiac rehabilitation, and multidisciplinary management. These measures may define high-quality care and highlight opportunities to improve the quality of care for adults hospitalized for heart failure.
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Affiliation(s)
- Giliana Garcia Acevedo
- Divisions of Internal Medicine and Palliative Care, Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada (G.G.A., A.A., B.S., M.M., J.M.L., S.M., K.L.Q.)
| | - Aisha Ahmad
- Divisions of Internal Medicine and Palliative Care, Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada (G.G.A., A.A., B.S., M.M., J.M.L., S.M., K.L.Q.)
- McMaster University, Hamilton, Ontario, Canada (A.A.)
| | - Benjamin Stall
- Divisions of Internal Medicine and Palliative Care, Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada (G.G.A., A.A., B.S., M.M., J.M.L., S.M., K.L.Q.)
| | - Media Mokhtarnia
- Divisions of Internal Medicine and Palliative Care, Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada (G.G.A., A.A., B.S., M.M., J.M.L., S.M., K.L.Q.)
- Queen's University, Kingston, Ontario, Canada (M.M.)
| | - John M Lapp
- Divisions of Internal Medicine and Palliative Care, Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada (G.G.A., A.A., B.S., M.M., J.M.L., S.M., K.L.Q.)
- Northern Ontario School of Medicine, Sudbury, Canada (J.M.L.)
| | - Amol A Verma
- Department of Medicine (A.A.V., F.R., E.E., K.L.Q.), University of Toronto, Ontario, Canada
- Division of General Internal Medicine, St Michael's Hospital, Unity Health Toronto, Ontario, Canada (A.A.V.)
| | - Jalal Ebrahim
- Division of Palliative Care, Department of Medicine (J.E.), University of Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Ontario, Canada (J.E.)
| | - Harriette G C Van Spall
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (H.C.G.V.S.)
- Hamilton Health Sciences, Ontario, Canada (H.C.G.V.S.)
| | - Fahad Razak
- Department of Medicine (A.A.V., F.R., E.E., K.L.Q.), University of Toronto, Ontario, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Ontario, Canada (F.R.)
| | - Sarina R Isenberg
- Department of Family and Community Medicine (S.R.I.), University of Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada (S.R.I.)
- Department of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada (S.R.I.)
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.R.I.)
| | - Edward Etchells
- Department of Medicine (A.A.V., F.R., E.E., K.L.Q.), University of Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (E.E.)
- Sunnybrook Research Institute, Toronto, Ontario, Canada (E.E., D.T.K.)
- Women's College Hospital, Toronto, Ontario, Canada (E.E.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (E.E., D.T.K.)
| | - Susanna Mak
- Divisions of Internal Medicine and Palliative Care, Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada (G.G.A., A.A., B.S., M.M., J.M.L., S.M., K.L.Q.)
- Division of Cardiology, Department of Medicine (S.M., S.P.), , University of Toronto, Ontario, Canada
| | - Leah Steinberg
- Division of Palliative Care and Temmy Latner Center for Palliative Care, Department of Family Medicine, Sinai Health System, Toronto, Ontario, Canada (L.S.)
| | - Dennis T Ko
- Sunnybrook Research Institute, Toronto, Ontario, Canada (E.E., D.T.K.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (E.E., D.T.K.)
- International Credential Evaluation Service, Canada (D.T.K.)
| | - Stephanie Poon
- Division of Cardiology, Department of Medicine (S.M., S.P.), , University of Toronto, Ontario, Canada
- Canadian Cardiovascular Society, Ottawa, Ontario, Canada (S.P.)
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (S.P.)
| | - Kieran L Quinn
- Divisions of Internal Medicine and Palliative Care, Department of Medicine, Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada (G.G.A., A.A., B.S., M.M., J.M.L., S.M., K.L.Q.)
- Department of Medicine (A.A.V., F.R., E.E., K.L.Q.), University of Toronto, Ontario, Canada
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Fu R, Feng S, Chen Q, Lin Y, Lin Z, Hu Z. Regulatory Relationships of Demographic, Clinical Characteristics and Quality of Care for Heart Failure Patients in Southern China. Int J Qual Health Care 2021; 34:6468985. [PMID: 34919681 DOI: 10.1093/intqhc/mzab159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/21/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Quality of care for Chinese patients with heart failure was substandard. It is of utmost value to ascertain the characteristics related to quality of care to narrow the gap. METHODS Data from 2,064 heart failure patients between 1 January 2012 and 31 December 2015 at a hospital in Fujian Province were analyzed. Bayesian Network was used to assess the regulatory relationships between demographic, clinical characteristics and compliance with quality indicators. RESULTS The compliance with quality indicators ranged from 42.5% to 90.2%. The compliance with recommended doses for medications all reached or was close to 100% except indapamide. In Bayesian network, residence place, hypertension, troponin, B-type natriuretic peptide, heart rate, lung disease, number of emergency treatment, ejection fraction directly regulated the compliance and gender, age, medical payment method, myocardiopathy, coronary heart disease, arrhythmia had indirectly effect. The lower compliance was found in patients under emergency treatment, patients with abnormal testing indicators, patients without specific comorbidities and patients with NRCMS or self-paying. Patients with lung disease and those who lived in urban area had longer length of stay. CONCLUSIONS The compliance with medication indicators for heart failure were suboptimal, but recommended doses were prescribed in patients who received medications. A series of strategies should be developed to improve the quality of care, such as expanding the scope and depth of knowledge of guidelines and clinical pathway, integrating the reminder and quality assessment model into hospital medical record information system, paying more attention to vulnerable population and improving the medical security system.
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Affiliation(s)
- Rong Fu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Shaodan Feng
- Emergency Department, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Qidong Chen
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
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