IT-2.1: Congestive Heart Failure (CHF) Admission Rate
Measure Title / IT-2.1 Congestive Heart Failure (CHF) Admission Rate /Description / Admissions with a principal diagnosis of heart failure per 100,000 population, ages 18 years and older.
NQF Number / Not applicable
Measure Steward / Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQI #8)
Link to measure citation / http://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V41/TechSpecs/PQI%2008%20CHF%20Admission%20Rate.pdf
Measure type / Standalone (SA)
Performance and Achievement Type / Pay-for-Reporting: Prior Authorization
DSRIP-specific modifications to Measure Steward’s specification / None
Denominator Description / Population ages 18 years and older in metropolitan area[1] or county.
Denominator Inclusions / Discharges in the numerator are assigned to the denominator based on the metropolitan area or county of the patient residence, not the metropolitan area or county of the hospital where the discharge occurred.
Denominator Exclusions / None
Denominator Size / Providers must report a minimum of 30 cases per measure during a 12-month measurement period (15 cases for a 6-month measurement period)
· For a measurement period (either 6 or 12 months) where the denominator size is less than or equal to 75, providers must report on all cases. No sampling is allowed.
· For a measurement period (either 6 or 12 months) where the denominator size is less than or equal to 380 but greater than 75, providers must report on all cases (preferred, particularly for providers using an electronic health record) or a random sample of not less than 76 cases.
· For a measurement period (either 6 or 12-months) where the denominator size is greater than 380, providers must report on all cases (preferred, particularly for providers using an electronic health record) or a random sample of cases that is not less than 20% of all cases; however, providers may cap the total sample size at 300 cases.
Numerator Description / Discharges, for patients ages 18 years and older, with a principal ICD-9-CM diagnosis code for heart failure x 100,000*.
Numerator Inclusions / Include ICD-9-CM diagnosis codes:
39891 RHEUMATIC HEART FAILURE 42831 AC DIASTOLIC HRT FAILURE OCT02-
4280 CONGESTIVE HEART FAILURE 42832 CHR DIASTOLIC HRT FAIL OCT02-
4281 LEFT HEART FAILURE 42833 AC ON CHR DIAST HRT FAIL OCT02-
42820 SYSTOLIC HRT FAILURE NOS OCT02- 42840 SYST/DIAST HRT FAIL NOS OCT02- 42821 AC SYSTOLIC HRT FAILURE OCT02- 42841 AC SYST/DIASTOL HRT FAIL OCT02-
42822 CHR SYSTOLIC HRT FAILURE OCT02- 42842 CHR SYST/DIASTL HRT FAIL OCT02-
42823 AC ON CHR SYST HRT FAIL OCT02- 42843 AC/CHR SYST/DIA HRT FAIL OCT02- 42830 DIASTOLC HRT FAILURE NOS OCT02- 4289 HEART FAILURE NOS
*The multiplier of 100,000 is to reflect the "per 100,000" that will result once the numerator is divided by the denominator
Numerator Exclusions / Exclude cases:
• with any-listed ICD-9-CM procedure codes for cardiac procedure
• transfer from a hospital (different facility)
• transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)
• transfer from another health care facility
• with missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)
See Prevention Quality Indicators Appendices (refer to measure citation link):
• Appendix A – Admission Codes for Transfers
• Appendix B – Cardiac Procedure Codes
Setting / Inpatient
Data Source / Administrative Claims, Electronic Health Records
Allowable Denominator Sub-sets / All denominator subsets are permissible for this outcome
09/24/14
[1] The term “metropolitan area” (MA) was adopted by the U.S. Census in 1990 and referred collectively to metropolitan statistical areas (MSAs), consolidated metropolitan statistical areas (CMSAs) and primary metropolitan statistical areas (PMSAs). In addition, “area” could refer to either 1) FIPS county, 2) modified FIPS county, 3) 1999 OMB Metropolitan Statistical Area or 4) 2003 OMB Metropolitan Statistical Area. Micropolitan Statistical Areas are not used in the QI software.