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Heart Care

Heart Attack: Prescribing ACE Inhibitors and ARBs on Discharge

What are we measuring?

The percentage of patients who receive an ACE Inhibitor or ARB on discharge to treat and prevent further heart attacks.

Why is this important?

Heart attack patients benefit from the use of medicines known as ACE (angiotensin converting enzyme) Inhibitors and ARBs (angiotensin receptor blockers) to treat heart attacks, heart failure, or a decreased function of the heart. These medicines block a hormone in the body that is responsible for causing the blood vessels to narrow. They can significantly reduce the risk of death after a heart attack.

What is our most recent performance and trend? 

 

What are we doing to improve our performance?

 BIDMC reviews every individual case where we fall below recommended practice and looks for ways to more consistently provide the right care and the right documentation of the care.

Heart Attack: Administering Aspirin on Arrival

What are we measuring? 

The percentage of heart attack patients who receive an aspirin on arrival at the hospital. 

Why is this important? 

Aspirin is an inexpensive, safe, and effective treatment for heart attack. While not appropriate for all patients, aspirin can help keep blood clots from forming that can cause heart attacks. 

What is our most recent performance and trend?

Heart Attack: Administering Aspirin at Discharge 

What are we measuring? 

The percentage of heart attack patients given a presecription for aspirin at discharge. 

Why is this important? 

Aspirin is an inexpensive, safe, and effective way to help reduce the risk of a first heart attack, or a recurring heart attack for some patients.  Appropriate heart attack patients should be given a prescription for aspirin when they are discharged from the hospital. 

What is our most recent performance and trend? 

Heart Attack: Administering Beta Blockers at Discharge

What are we measuring? 

The percent of heart attack patients given a prescription for beta blockers at discharge. 

Why is this important? 

Beta blockers are a type of medicine used to lower blood pressure, treat chest pain (angina), and treat heart failure which can help prevent a future heart attack. 

What is our most recent performance and trend?

Heart Attack Mortality & Readmission Rates

What are we measuring? 

30-day Mortality Rate 

The percentage of patients who died within 30 days of being admitted for heart attack (acute myocardial infarction) care at BIDMC. Patients may have died while in the hospital or after they were discharged from BIDMC. The cause of patient death may have been related to the heart attack or any other condition.

 

30-Day Readmission Rate 

The percentage of patients who are re-admitted to a hospital within 30 days of being admitted for heart attack (acute myocardial infarction) care at BIDMC. The re-admission may have been planned as part of follow-up care, or unplanned at the time of hospital discharge. Unplanned readmissions may have been due to a condition related to the heart attack, or may have been due to any other condition. Re-admission to the hospital may or may not have been avoidable by measures taken before the patient was discharged from the hospital. 

 

Why is this important? 

30-day Mortality Rates and 30-Day Readmission Rates are two measures related to the quality of care provided to patients while hospitalized, during the discharge planning process, and in the transition of care after hospitalization. Our goal is to keep 30-day mortality rates as low as possible, and prevent avoidable rehospitalizations after discharge. 

What are we doing to improve our performance? 

Readmissions may reflect a breakdown in coordination of care after a patient leaves the hospital. To improve care coordination after discharge, BIDMC has initiated a workgroup called the Cross Continuum Care Coordination Team to identify new approaches to ensuring effective transitions and follow-up after our patients leave the hospital. Our Team includes patients, family members, and representatives from primary care practices, VNA and home care agencies, skilled nursing and rehabilitation facilities, elder services, payers, and community service organizations. The Team meets monthly to share best practices, review improvement opportunities, and develop more effective care transition processes.

Two pilot programs are now underway utilizing the approaches identified by the Cross Continuum Care Coordination Team. 

  • In BIDMC's largest primary care practice, Health Care Associates, HCA nurses meet with patients during their hospitalization and coordinate the patient's care for 30 days after the patient is leaves the hospital. A Pharmacist is also available to address complex medication issues, and a Care Transitions Coach provides additional support to help patients successfully follow discharge instructions and embrace actions to promote health.
  • For our cardiology patients, we have established "Heartline" a telephone number provided to all patients discharged from our Cardiology service, in case they have questions or concerns about their condition, the onset of any symptoms, or recommended discharge instructions and follow-up care. 

Heart Failure: Left Ventricular Function Assessment

What are we measuring? 

Percent of heart failure patients who had an assessment of left ventricular function (LVF). 

Why is this important? 

Heart failure patients should have tests, such as echocardiograms, to assess how the left chamber of the heart is pumping.  An echocardiogram is a test that creates a moving picture of the heart using sound waves. BIDMC gathers this diagnostic information to determine how best to treat the patient. 

What is our most recent performance and trend?

Heart Failure: Prescribing ACE Inhibitors and ARBs on Discharge

What are we measuring? 

The percent of heart failure patients given a prescription for ACE Inhibitors or ARB for left ventricular systolic dysfunction at discharge. 

Why is this important? 

Medicines known as ACE (angiotensin converting enzyme) Inhibitors and ARBs (angiotensin receptor blockers) are used to treat heart attacks, heart failure, and problems associated with the left side of the heart. In order to prevent future heart failure and reduce the risk of death, most heart failure patients should receive a prescription for ACE Inhibitors before they are discharged from the hospital. 

What is our most recent performance and trend? 

Heart Failure: Providing Discharge Instructions for Self-Management

What are we measuring? 

Percent of heart failure patients given comprehensive discharge instructions for management of symptoms at home. 

Why is this important? 

When heart failure patients are discharged from the hospitals, the staff should give them information that helps them manage the symptoms of heart failure including information on medications, weight monitoring, nutrition and diet, management of symptoms worsening, and contact/follow up instructions. 

What is our most recent performance and trend?

What are we doing to improve our performance? 

BIDMC physicians and nurses ensure that self-management instructions are reviewed and important information is thoroughly explained to heart failure patients when they are discharged. 

Heart Failure Mortality & Readmission Rates

What are we measuring?

30-day Mortality Rate

The percentage of patients who died within 30 days of being admitted for heart failure care at BIDMC. Patients may have died while in the hospital or after they were discharged from BIDMC. The cause of patient death may have been related to the heart failure or may have been due to an unrelated cause of death.

 

30-Day Readmission Rate

The percentage of patients who are re-admitted to a hospital within 30 days of being admitted for heart failure care at BIDMC. The re-admission may have been planned as part of follow-up care, or unplanned at the time of hospital discharge. Unplanned readmissions may have been due to a condition related to the heart failure, or may have been due to an unrelated condition. Re-admission to the hospital may or may not have been avoidable by measures taken before the patient was discharged from the hospital.

 

Why is this important?

30-day Mortality Rates and 30-Day Readmission Rates are two measures related to the quality of care provided to patients while hospitalized, during the discharge planning process, and in the transition of care after hospitalization. Our goal is to keep 30-day mortality rates as low as possible, and prevent avoidable rehospitalizations after discharge.

What are we doing to improve our performance?

Readmissions may reflect a breakdown in coordination of care after a patient leaves the hospital. To improve care coordination after discharge, BIDMC has initiated a workgroup called the Cross Continuum Care Coordination Team to identify new approaches to ensuring effective transitions and follow-up after our patients leave the hospital. Our Team includes patients, family members, and representatives from primary care practices, VNA and home care agencies, skilled nursing and rehabilitation facilities, elder services, payers, and community service organizations. The Team meets monthly to share best practices, review improvement opportunities, and develop more effective care transition processes.

Two pilot programs are now underway utilizing the approaches identified by the Cross Continuum Care Coordination Team.

  • In BIDMC's largest primary care practice, Health Care Associates, HCA nurses meet with patients during their hospitalization and coordinate the patient's care for 30 days after the patient is leaves the hospital. A Pharmacist is also available to address complex medication issues, and a Care Transitions Coach provides additional support to help patients successfully follow discharge instructions and embrace actions to promote health.
  • For our cardiology patients, we have established "Heartline" a telephone number provided to all patients discharged from our Cardiology service, in case they have questions or concerns about their condition, the onset of any symptoms, or recommended discharge instructions and follow-up care. 

Other Publicly Reported Measures:

Last updated: June 2014