Improving Core Measure Compliance in Heart Failure: A Performance Improvement Initiative

Nancy M. DeRita, Steven E. Minnick, Susan M. Szpunar, Kandace Fitzpatrick, Dorine Berriel-Cass


Background: The National Hospital Quality Initiative, endorsed by the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), has identified heart failure (HF) as a focus area for quality improvement. HF is a chronic, progressive medical condition that has shown an epidemic increase in prevalence over the last 20 years. St. John Hospital and Medical Center (SJH&MC) has identified the HF core measures as an area for improvement. The Continuing Medical Education (CME) program at SJH&MC has collaborated with the Quality Assurance (QA) department to design a Performance Improvement–Continuing Medical Education (PI-CME) initiative that will serve to both improve compliance with the HF core measures and provide a valuable learning opportunity for physicians. Participation in this PI-CME activity will allow physicians to receive AMA PRA category 1 credit™ as well as meet the JCAHO credentialing requirement in the general competency area of Practice-Based Learning and Improvement (PBLI).

Method: The design of the PI-CME initiative for HF involved several key steps: 1) developing a PI-CME plan to address improvement in HF core measure compliance; 2) meeting with key physicians to discuss the concepts of PI-CME and to obtain buy-in; 3) working closely with the QA department to gather relevant baseline and postimplementation data; 4) data analysis and dissemination of findings to participating physicians; and 5) reflective learning based on the findings and re-evaluation for purposes of further quality improvement. The CME Specialist, the Director of Medical Education, and the QA Department met to discuss the strategies in place to address the performance gap in the HF core measures at SJH&MC, and how this performance gap might serve as the basis for a physician PI-CME initiative. The PI-CME initiative was designed based upon the QA Department’s current mechanism of identifying physicians who have instances of noncompliance with core measures. A pilot group of physicians was identified to participate in the PI-CME activity. With the PI-CME plan developed, meetings with key physicians will be held to discuss the concepts, requirements, and benefits of PI-CME and to obtain buy-in. The initiative will be evaluated by comparing preintervention compliance rates with postimplementation compliance rates within the targeted study group and hospital-wide. Data will be disseminated to participating physicians for the purposes of reflective learning.

Conclusion: This initiative will provide a mechanism (PI-CME) for quality improvement that will complement a rule indicator approach currently in use. We believe PI-CME has the important added dimensions of providing participating physicians CME credit, providing PBLI activity applicable toward hospital re-credentialing, and engaging the physician in a more meaningful educational opportunity that involves both active and reflective learning as part of the quality improvement initiative.

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