Effect of compliance with quality performance measures for heart failure on clinical outcomes in high-risk patients

Background: Although effects of the Joint Commission on Accreditation of Healthcare Organizations' (TJC) performance measures on national trends in patient outcomes have been reported, little information exists on the effects of these quality measures on patient outcomes in individual centers caring for high-risk patient populations. Objectives: To determine the effects of compliance with TJC core quality measures for heart failure on patient outcomes at a university hospital caring for high-risk patients. Methods: We reviewed data collected for TJC in patients admitted with heart failure at a university hospital serving an indigent population in Louisiana. Patients were divided based on compliance with TJC measures into quality-compliant or quality-deficient groups. Of 646 reviewed records, 542, representing 357 patients, were included in the analysis. There were 193 patients in the quality-compliant and 164 in the quality-deficient group. Outcome measures included rate of heart failure admission/year and readmission within 90 days. Multivariate logistic and linear regression analyses were performed to identify independent associations between patient characteristics and heart failure admission. Results: Multiple linear regression analysis demonstrated higher rates of heart failure admission/year, and multiple logistic regression revealed higher readmissions at 90 days in the quality-compliant group (parameter estimate, 0.203; p = .02; odds ratio, 2.82; 95% confidence interval, 1.46-5.44, respectively). Conclusion: Compliance with TJC quality measures for heart failure at a university hospital in Louisiana was associated with higher readmission rates for heart failure. Several factors may explain this trend, including patient characteristics and focus on national reporting benchmarks rather than patient-centered health care.