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Congestive heart failure (CHF) is one of the leading causes of morbidity and mortality worldwide, (Al-Shamiri, 2013) and it has a negative impact on patient's quality of life (QoL) and healthcare costs (AlHabib et al., 2011). CHF is a major public health problem and financial burden on all healthcare systems, particularly in developed countries (Liao, Allen, & Whellan, 2008; Redfield et al., 2003). It is a common condition with a high prevalence rate of 1-2% in developed countries, with a 10% prevalence rate in adults aged 70 years or older (Mosterd & Hoes, 2007). In the US, annual CHF expenditure is estimated to be as high as $38 billion, of which $23 billion are for hospitalization costs (O'Connell & Bristow, 1994). In Europe, a million hospitalizations are attributed to acute CHF each year (Gheorghiade et al., 2005).
Despite continuous improvement of various treatments commonly offered for CHF patients, the prognosis remains poor, with a mortality rate of 47-60% within 5 years (Levy et al., 2002). The majority of CHF patients are elderly and have comorbidities that lower their tolerance to standard CHF medication doses (Rich, 2012); subsequently, they are more prone to acute decompensated CHF episodes and require frequent hospitalization (Levy et al., 2002).
Quality measurement is not a new concept, but approaches to achieve it vary. The model of quality measurement in health care has diverged from the vision of universal quality assessment and measurement based on committees, focusing on utilization and medical care review. CHF has been a major focus of quality initiatives due to its high prevalence, and its major impacts on individuals, health systems, and even national economies (DeFrances, Lucas, Buie, & Golosinskiy, 2008). As mentioned previously, the most egregious costs of CHF are associated with hospitalization (O'Connell & Bristow, 1994). CHF readmission rate is 26% higher than for other conditions (Jencks, Williams, & Coleman, 2009). CHF patients are also at high risk of developing adverse consequences, including poor QoL and even death (F. A. Masoudi, Havranek, & Krumholz, 2002). This is despite the extensive evidence base on treating CHF, which has resulted in the development of robust practice guidelines for its management (Hunt et al., 2005).
Major improvements have been made in key processes of AMI care since the early 1990s (Marciniak et al., 1998) inspiring similar attempts for cardiovascular surgery care (F. L. Grover, Hammermeister, & Burchfiel, 1990; Frederick L. Grover et al., 1994; Krumholz et al., 1997). CHF treatment has lagged, and significant gaps in the QoC delivered for CHF patients have been identified (Gregg C. Fonarow & Peterson, 2009; Havranek et al., 2002; Frederick A. Masoudi, Ordin, Delaney, Krumholz, & Havranek, 2000).
Since then, the quality measurement for CHF has evolved and the measurement scope expanded beyond processes of care and the measurement usage expanded beyond the initial aim of payment reimbursement and accreditation.
Process measures have strong face validity, as they are built upon the most robust evidence. However, they have limitations (F. A. Masoudi et al., 2004; Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety, 2011).