 | Hospital Quality
Alliance (HQA): “Improving Care Through Information”
Centers for Medicare and Medicaid Services has several efforts in progress to provide hospital quality information to consumers and others and improve the care provided by the nation's hospitals. These initiatives build upon strategies to identify illnesses and/or clinical conditions that affect Medicare beneficiaries in order to:
- promote the best medical practices associated with the targeted clinical disorders
- prevent or reduce further instances of these selected clinical disorders
- prevent related complications
What is a heart attack?
The American Heart Association defines a heart attack as a condition that occurs when the blood supply to part of the heart muscle itself – the myocardium is reduced severely or stopped. The reduction or stoppage happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked. The medical term for heart attack is myocardial infarction.
Why is quality hospital care important for heart attack patients?
Heart disease, including heart attacks, is the leading cause of death in the United States. Each year, more than one million people in the United States have heart attacks. About one third, or 350,000 individuals, die from heart attacks. When a patient is given appropriate medical care as soon as possible after a heart attack, the potential for recovery increases greatly. Receiving the correct medications in the days and weeks after a heart attack, as well as lifestyle changes and rehabilitation activities, also can prevent another heart attack. Currently recommended care for myocardial infarction includes:
Patients with acute myocardial infarction who received aspirin within 24 hours after hospital arrival result in a significant reduction in adverse events and subsequent mortality.
Prescribing aspirin therapy for patients with acute myocardial infarction at the time of hospital discharge reduces the risk of adverse events and mortality.
A reduction in mortality and morbidity has been shown when patients with left systolic ventricular dysfunction are prescribed medications called ACE inhibitors.
Prescribing medications called beta-blockers at the time of hospital discharge for patients who have suffered an acute myocardial infarction can reduce mortality and morbidity.
Smoking cessation reduces mortality and morbidity in all populations. Patients who have had a myocardial infarction and receive even brief smoking cessation advice are more likely to quit.
What is heart failure?
Heart failure (also known as congestive heart failure), as defined by the American Heart Association, is a condition that occurs when the heart fails to effectively pump blood through the heart and to the body and major organs. This usually occurs when the heart has been weakened throughout time by an underlying problem, such as clogged arteries, high blood pressure, a defect in the heart’s muscular walls or valves or some other medical condition.
Why is quality hospital care important for patients with heart failure?
Heart failure affects nearly five million people in the United States. Approximately 500,000 to one million new cases of heart failure are diagnosed each year. Hospitalization is common for heart failure patients, and receiving proper care is important for people with heart failure to prevent further hospital visits and improve the quality of their lives.
Currently recommended care for heart failure patients include:
Prescribing medications called ACE inhibitors in heart failure patients with left systolic ventricular dysfunction reduces mortality and morbidity.
Normal guidelines advocate the assessment of left systolic ventricular dysfunction is the single most important diagnostic test in the management of patients with heart failure. Note: In order for hospitals to be credited for meeting the indicator, not only does LVF need to be measured (via echocardiogram, heart catheterization, etc) but the results of these tests need to be recorded in the patient’s medical record for each and every subsequent hospitalization. Often times, although the results of such testing are always readily retrievable, the information is not always re-recorded in the medical record of every admission.
Patient non-compliance with diet and medications is an important reason for changes in clinical status. Healthcare professionals should ensure that patients and their families understand their dietary restrictions, activity recommendations, prescribed medication regimen and the signs and symptoms of worsening heart failure.
National guidelines strongly recommend smoking cessation counseling for smokers with cardiovascular disease, including heart failure.
Percent of Heart Failure Patients Given an Evaluation of Left Ventricular Systolic (LVS) Function
Why is this Important?
The proper treatment for heart failure depends on what area of your heart is affected. An important test is to check how your heart is pumping, called an “evaluation of the left ventricular systolic function.” It can tell your health care provider whether the left side of your heart is pumping properly. Other ways to check on how your heart is pumping include: your medical history, a physical examination, listening to your heart sounds, other tests as ordered by a physician (like an ECG (electrocardiogram), chest x-ray, blood work, and an echocardiogram) Higher percentages are better.
What is pneumonia?
Pneumonia is defined by the American Lung Association as a serious infection or inflammation of the lungs.
Why is quality hospital care important for patients with pneumonia?
Each year, two to three million cases of pneumonia result in 10 million doctor visits, as well as 500,000 hospitalizations and 45,000 deaths. Patients receiving recommended care for pneumonia are less likely to require return visits to a hospital.
Currently recommended care for pneumonia patients include:
Assessing pneumonia patients with arterial blood gas or pulse oximetry within 24 hours of hospital arrival and giving supplemental oxygen if indicated has shown to decrease mortality.
Pneumococcal vaccination is indicated for person 65 years of age and older because it is up to 75% effective in preventing pneumococcal bacteremia and meningitis.
There is growing clinical evidence of an association between timely inpatient administration of antibiotics and improved outcomes among pneumonia patients.
Improved survival has been associated with optional therapy. Clinical information is improved if a blood culture is obtained before antibiotics are administered.
Tobacco use is the single greatest cause of disease in the United States – smoking accounts for one out of every 5 deaths in the United States and is the most important modifiable cause of premature death.
Percent of Pneumonia Patients Assessed and Given Influenza Vaccination
Why is this Important?
Flu shots reduce the risk of influenza, a serious and sometimes deadly lung infection that can spread quickly in a community or facility. Hospitals should check to make sure that pneumonia patients, particularly those who are age 50 or older, get a flu shot during flu season to protect them from another lung infection and to help prevent the spread of influenza.
Since a flu shot is effective for just one flu season, the period of time used to calculate this rate is the flu season (from approximately November through March), in contrast to other measures on Hospital Compare, which are generally collected throughout the year.
Higher percentages are better.
Percent of Pneumonia Patients Given Initial Antibiotic(s) within 4 Hours After Arrival
Why is this Important?
Antibiotics are used to treat adults with pneumonia caused by bacteria. Early treatment with antibiotics can cure bacterial pneumonia and reduce the possibility of complications. This information shows the percent of patients who were given their first dose of antibiotics within 4 hours of arrival at the hospital. Patients who get pneumonia during their stay at the hospital are not counted in this measure.
Higher percentages are better.
Percent of Pneumonia Patients Given the Most Appropriate Initial Antibiotic(s)
Why is this Important?
Pneumonia is a lung infection that is usually caused by bacteria or a virus. If pneumonia is caused by bacteria, hospitals will treat the infection with antibiotics. Different bacteria are treated with different antibiotics. To learn about how hospitals use a blood test to choose the most effective treatment for pneumonia patients, refer to the Process of Care measure named 'Percent of Pneumonia Patients Whose Initial Emergency Room Blood Culture Was Performed Prior To The Administration Of The First Hospital Dose Of Antibiotics'.
Higher percentages are better.
Surgical Care Improvement/Surgical Infection Prevention
Hospitals can improve surgical care and reduce the risk of wound infection after surgery by providing the right medicines at the right time on the day of surgery.
There are also steps that you, as a patient, can take to make sure the surgery is as safe as possible. For example, your doctor or nurse can tell you how to wash with an antibiotic soap the day before surgery. You can also give your doctor or nurse a list of all your medications, including vitamins, herbal medicines, and over-the-counter medications. You should also tell your doctor or nurse about any allergies and bad reactions to anesthesia.
Percent of Surgery Patients Who Received Preventative Antibiotic(s) One Hour Before Incision
Why is this Important?
Antibiotics are medicines to prevent and treat infections. Research shows that surgery patients who get antibitics within the hour before their operation are less likely to get wound infections. Getting an antibiotic earlier, or after surgery begins, is not as effective. Higher percentages are better.
Percent of Surgery Patients Who Received the Appropriate Preventative Antibiotic(s) for Their Surgery
Why is this Important?
Certain antibiotics are recommended to help prevent wound infection for particular types of surgery. This measure looks at how often hospital surgical patients get the appropriate antibiotic in order to prevent a surgical wound infection.
Infections continue to be the main preventable complication of most surgical procedures. Antibiotics are medicines to prevent and treat infections. By following the standard guidelines for timing and giving you the correct antibiotic drug, hospitals can reduce your risk of getting a wound infection after surgery.
Hospitals can reduce the risk of wound infection after surgery by making sure patients get the right medicines at the right time on the day of their surgery. Higher percentages are better.
Percent of Surgery Patients Who Received Treatment To Prevent Blood Clots Within 24 Hours Before or After Selected Surgeries to Prevent Blood Clots
Why is this Important?
Treatment(s) to prevent blood clots must be given at the right time to prevent blood clots forming after selected surgeries.
Venous thrombosis is a condition in which a blood clot (thrombus) forms in a vein. This clot can limit blood flow, causing swelling, redness and pain. Most commonly, clots occur in the legs, thighs, or pelvis.
If a part or all of the clot breaks off from where it was formed, it can travel through the veins. The part that breaks off is called an embolus. If the embolus lodges in the lung, it is called a pulmonary embolism, a serious condition that can cause death.
A number of factors can increase a patient’s risk of developing blood clots, but doctors can order preventive treatments called prophylaxis to reduce the risk. Prophylaxis may include blood thinning medications, elastic support stockings, or mechanical air stockings that promote circulation in the legs. Higher percentages are better.
Percent of Surgery Patients Whose Doctors Ordered Treatments to Prevent Blood Clots (Venous Thromboembolism) For Certain Types of Surgeries
Why is this Important?
Certain types of surgery can increase the risk of blood clots forming in the veins. This is because patients don’t move much during and, usually, after some surgeries.
Venous thrombosis is a condition in which a blood clot (thrombus) forms in a vein. This clot can limit blood flow, causing swelling, redness and pain. Most commonly, clots occur in the legs, thighs, or pelvis.
If a part or all of the clot breaks off from where it was formed, it can travel through the veins. The part that breaks off is called an embolus. If the embolus lodges in the lung, it is called a pulmonary embolism, a serious condition that can cause death.
A number of factors can increase a patient’s risk of developing blood clots, but doctors can order preventive treatments called prophylaxis to reduce the risk. Prophylaxis may include blood thinning medications, elastic support stockings, or mechanical air stockings that promote circulation in the legs. Higher percentages are better.
Percent of Surgery Patients Whose Preventative Antibiotic(s) are Stopped Within 24 hours After Surgery
Why is this Important?
Antibiotics are medicines to prevent and treat infections. While the likelihood of infection after surgery can be reduced by giving patients preventative antibiotics, taking these antibiotics for more than 24 hours after routine surgery is usually not necessary and can increase the risk of side effects such as stomach aches, serious types of diarrhea, and antibiotic resistance (when antibiotics are used too much, they will not work anymore.) There are exceptions – for example, where the surgical site has been contaminated (making the surgery not routine).Talk to your doctor if you have questions about how long you should take antibiotics after surgery. Higher percentages are better.
*National hospital participating in CMS Quality Alliance Initiative >4,000 participating hospitals.
**MIDAS – National Comparative Data Base; >1,000 participating hospitals.
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