BackgroundNumerous quality metrics for heart failure (HF) care now exist based on process and outcome. What remains unclear, however, is if the correct quality metrics are being emphasized. To determine the validity of certain measures, we compared correlations between measures and reliability over time. Measures assessed include guideline-recommended β-blocker (BB), any BB, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker, mineralocorticoid receptor antagonist, and hydralazine/isosorbide dinitrate (in blacks) use among candidates, 30-day mortality, 1-year mortality, and 30-day readmission.Methods and ResultsThis was an observational cohort analysis using chart review and electronic resources for 55 735 patients from 102 Veterans Affairs medical centers hospitalized with HF from 2008 to 2013. Assessments of convergent validity and reliability were performed. Significant correlations were found between in-hospital rates of ACE inhibitor use and the following measures: BB use, 30-day mortality, and 1-year mortality. Guideline-recommended BB use was also significantly correlated with mineralocorticoid receptor antagonists, 30-day mortality, and 1-year mortality. There was no correlation between 30-day readmission rates and any therapy or mortality. Measure reliability over time was seen for guideline-recommended BBs (r=0.57), mineralocorticoid receptor antagonists (r=0.50), 30-day mortality (r=0.29), and 1-year mortality (r=0.31). ACE inhibitor and readmission rates were not reliable measures over time.ConclusionsBB use, ACE inhibitor use, mortality, and mineralocorticoid receptor antagonist use are valid measures of HF quality. Thirty-day readmission rate did not seem to be a valid measure of HF quality of care. If the goal is to identify high-quality HF care, the emphasis on decreasing readmission rates might be better directed towards improving usage of the recommended therapies.

中文翻译：

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心力衰竭的绩效和结果措施的有效性

背景技术现在存在基于过程和结果的多种心力衰竭（HF）护理质量指标。然而，尚不清楚的是，是否强调了正确的质量指标。为了确定某些措施的有效性，我们比较了措施与可靠性之间的相关性。评估的措施包括指南推荐的β-受体阻滞剂（BB），任何BB，血管紧张素转化酶（ACE）抑制剂或血管紧张素受体阻滞剂，盐皮质激素受体拮抗剂和候选药物肼苯哒嗪/异山梨醇二硝酸盐（黑色）的使用，30天死亡率，1年死亡率和30天再入院。方法与结果这是一项观察性队列分析，使用图表审阅和电子资源对2008年至2013年来自102例HF住院的退伍军人事务医疗中心的55 735名患者进行了观察。对收敛效度和可靠性进行了评估。在院内使用ACE抑制剂的比率与以下措施之间存在显着的相关性：BB的使用，30天的死亡率和1年的死亡率。指南推荐的BB使用率也与盐皮质激素受体拮抗剂，30天死亡率和1年死亡率显着相关。30天再入院率与任何治疗或死亡率之间均无相关性。对于指南推荐的BB，可以看到随着时间的推移，其测量的可靠性（和1年死亡率。30天再入院率与任何治疗或死亡率之间均无相关性。对于指南推荐的BB，可以看到随着时间的推移，其测量的可靠性（和1年死亡率。30天再入院率与任何治疗或死亡率之间均无相关性。对于指南推荐的BB，可以看到随着时间的推移，其测量的可靠性（r = 0.57），盐皮质激素受体拮抗剂（r = 0.50），30天死亡率（r = 0.29）和1年死亡率（r = 0.31）。ACE抑制剂和再入院率不是随时间推移的可靠指标。结论BB的使用，ACE抑制剂的使用，死亡率和盐皮质激素受体拮抗剂的使用是有效的HF质量指标。30天的再入院率似乎并不是衡量HF护理质量的有效指标。如果目标是确定高质量的HF护理，则对降低再入院率的强调可能会更好地指向改善推荐疗法的使用。