AHA, TJC get with the guidelines for heart failure

AHA updates guidelines for hospitalized patients

In conjunction with the American Heart Association's updated Get With The Guidelines program on heart failure, The Joint Commission is now offering hospitals a certificate of distinction in heart failure, as part of its disease-specific care advanced certification program.

The advanced certification program is "differentiated from accreditation in a number of ways," says Jean E. Range, MS, RN, CPHQ, executive director, disease-specific care certification. "Accreditation, of course, is an overall evaluation of health care from top to bottom including bricks and mortar, as we like to say. Certification is a focused evaluation of a clinical treatment program" that evolved beginning in the late 90s with "the burgeoning population of Americans with chronic diseases, all the baby boomers, and the realization by health care providers that our delivery system really doesn't have the structure to optimize care of patients with chronic diseases."

To gain certification, compliance with certain standards is required, as well as acknowledgment that "a formalized program is in place and that the structure of the program is adequate in that the leadership has ensured that adequate resources are going" to be available to the clinical team providing care.

A huge component of this and managing chronic conditions, Range says, is patients' self-management. The provider of care must be prepared to share clinical information with other providers "touching all points of the continuum of care" as these patients may be hospitalized or require home or long-term care. Hospitals must also show a systematic approach to dealing with the condition and that the care is evidence-based.

For heart failure certification, The Joint Commission also requires participating hospitals to "achieve and sustain for 90 days or more at least 85% of the achievement measures" of the AHA's Get With The Guidelines program on heart failure and to collect data on The Joint Commission's heart failure-related four core measures. The data collected must be used in facilities' ongoing improvement measures.

Evaluation of the latter is done on an annual basis for the two-year certification program, with Joint Commission personnel, one of whom is a clinical expert in the area of heart failure, visiting the facility every two years. In the middle of the "off" year, The Joint Commission has a conference call with the facility in which they "go over performance on the data collection and where they're at in terms of the measures themselves," Range says. Hospitals submit the results of their performance on a quarterly basis and report data on the core measures using an extranet portal. The cost for the two-year certification program is $9,200.

Get With The Guidelines changes

Updates to the AHA's guidelines on heart failure include a section specifically aimed at hospitalized patients "and there are a number of key recommendations with regard to care to provide during the hospital stay as well as key recommendations on that transition of care," says Gregg Fonarow, MD, chair of the Get With The Guidelines steering committee.

As part of the program, he says, AHA partners with individual hospitals. A key component is the web-based patient management tool, which AHA offers for a cost of $1,800. The tool allows "the clinician at the point of care to check that patient's care [against] the current version of the guidelines to ensure for each patient, each time the care being provided is evidence-based." It also provides benchmark quality reports, patient education materials, a link to coding instructions, information on drug therapies, and FAQs.

As far as benchmarking, Fonarow says, the case management tool allows you to capture historical and current ACE inhibitor or beta-blocker discharge rates and compare that to national benchmarks. Participating hospitals also can use the AHA's library of performance improvement tools, such as standardized order sets, charts, and checklists.

Participating hospitals can call the AHA help line for support, and field staff based in all of the organization's affiliates work closely with the local hospital teams.

Fonarow also says beginning in June, the Centers for Medicare & Medicaid Services is going to start publicly reporting rehospitalization rates for heart failure, myocardial infarction, and pneumonia. He adds "there's been hints from the administration that they're interested in aligning the incentives, so you can imagine how there would be an impact on reimbursement to hospitals" with regard to higher rehospitalizations.

Do the guidelines provide actionable recommendations? Fonarow says yes. "These are firm recommendations with regard to therapy that should be provided and those processes that are strongly linked to clinical outcomes. And there's also practical information provided as to who are the appropriate candidates for therapy, what are the doses, and what is the monitoring that is necessary." The Get With The Guidelines program addresses diagnosis, treatment of the patient in the outpatient settings, medications, and diagnostic tests. With the hospitalized patient, Fonarow says, "it takes you all the way through admission, special populations, end-of-life arrangements, quality improvement, and implementation of guidelines."