Quality of heart failure care in managed Medicare and Medicaid patients in North Carolina*☆,
Section snippets
Methods
Managed care plans serving the Medicare (n = 3) or Medicaid (n = 2) populations were invited to collaborate in this quality improvement project with Medical Review of North Carolina, the state quality improvement organization, and Wake Forest University School of Medicine. Plans were asked to identify via claims all patients with HF in the year 2000. On-site medical record abstraction was then performed at the office of the primary care provider of each identified HF patient. The inclusion
Results
We identified 3,299 patients with HF who were enrolled in managed care plans and who met the inclusion criteria. Chart abstraction was performed on 971 Medicare and 642 Medicaid patients with a confirmed diagnosis of HF. Medicare and Medicaid patients differed with respect to age, gender, and race (Table 1). Hypertension, diabetes, and cardiovascular disease were frequent comorbidities in both patient populations.
Overall, 88% of patients with HF underwent left ventricular function assessment (
Discussion
These data demonstrate high compliance with HF quality indicators in North Carolina–managed Medicare/Medicaid plans. We found a high rate of ventricular function assessment, and among the patients with systolic dysfunction, a high rate of ACE inhibitor prescription. Use of β blockers lagged behind the use of ACE inhibitors and represents an opportunity for improvement. We found no evidence for differential drug treatment by insurance, gender, or race; despite a high rate of ventricular function
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This study was suported by Contract 500-02-NC03 from the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, Atlanta, Georgia, and by a grant from the Association of Teachers of Preventive Medicine, Washington, DC.
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The analyses upon which this publication is based were performed under Contract 500-02-NC03, entitled “Utilization and Quality Control Peer Review Organization for the State of North Carolina,” sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The investigator assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare & Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the investigator concerning experience in engaging with issues presented are welcomed.