© Copyright, The Joint Commission Advanced Certification in Heart Failure Measures Pilot Test Training Part II: Tuesday, November 15, 2011

© Copyright, The Joint Commission Outpatient Setting

© Copyright, The Joint Commission 3 ACHF-04a Hospital Outpatient Assessment of Functional Status for Heart Failure Denominator: All heart failure patients Numerator: Patients for whom a NYHA Class OR completion of a valid, reliable disease- specific instrument was documented at the time of the initial outpatient visit.

© Copyright, The Joint Commission 4 ACHF-04a Included Populations  E/M Code for hospital outpatient encounter as defined in OP Appendix A, OP Table 1.0, and  An ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1

© Copyright, The Joint Commission 5 ACHF-04a Data Elements Denominator:  Birthdate  Discharge Status  E/M Code  ICD-9-CM Other Procedure Codes  ICD-9-CM Principal Diagnosis Code  ICD-9-CM Principal Procedure Code  Outpatient Encounter Date

© Copyright, The Joint Commission 6 ACHF-04a Data Elements Numerator:  Disease-Specific Instrument

© Copyright, The Joint Commission 7 ACHF-04a Algorithm Highlights

© Copyright, The Joint Commission 8 ACHF-05a Hospital Outpatient ICD Counseling for LVSD Denominator: Heart failure patients (NYHA Class II and III) AND documentation of a current LVEF < 35%, despite optimal medication (ACEI/ARB/BB) management for at least 3 months Numerator: Patients who receive ICD counseling when seen in the outpatient setting and have documentation of the discussion with a healthcare provider present in the medical record

© Copyright, The Joint Commission 9 ACHF-05a Included Populations  E/M Code for hospital outpatient encounter as defined in OP Appendix A, OP Table 1.0, and  An ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1  Documentation of LVSD < 35%  Documentation of Optimal Medication Management for at Least 3 Months  NYHA Class II / III

© Copyright, The Joint Commission 10 ACHF-05a Excluded Populations  Patients with NYHA Class I or IV heart failure  Patients with a documented Reason for No ICD Counseling in the Outpatient Setting

© Copyright, The Joint Commission 11 ACHF-05a Data Elements Denominator:  Birthdate  Clinical Trial  Discharge Status  E/M Code  ICD-9-CM Other Procedure Codes  ICD-9-CM Principal Diagnosis Code  ICD-9-CM Principal Procedure Code  LVSD < 35%

© Copyright, The Joint Commission 12 ACHF-05a Data Elements Denominator:  Optimal Medical Management For at least 3 Months  Outpatient Encounter Date  Reason for No ICD Counseling in the Outpatient Setting Numerator:  ICD Counseling

© Copyright, The Joint Commission 13 ACHF-05a Algorithm Highlights

© Copyright, The Joint Commission 14 ACHF-05b Hospital Outpatient Cardiac Resynchronization Therapy (CRT, CRT with pacing CRT-P, CRT with defibrillator CRT-D) Denominator: Heart failure patients (NYHA Class II, III, or IV) with most recent LVSD < 35%, QRS duration on ECG of 150 ms or above, left bundle branch block (LBBB), and receiving optimal medication management for at least 3 months Numerator: Patients who have cardiac resynchronization therapy (CRT) when seen in the outpatient setting

© Copyright, The Joint Commission 15 ACHF-05b Included Populations  E/M Code for hospital outpatient encounter as defined in OP Appendix A, OP Table 1.0, and  An ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1  Documentation on ECG of Left Bundle Branch Block (LBBB) and QRS duration of 150 ms

© Copyright, The Joint Commission 16 ACHF-05b Included Populations  Documentation of LVEF < 35%  Documentation of New York Heart Association Classification II, III, or IV  Documentation of Optimal Medication Management for at Least 3 Months  Documentation on ECG of QRS duration of 150 ms or above

© Copyright, The Joint Commission 17 ACHF-05b Excluded Populations  Patients with NYHA Class I heart failure  Patients with a documented Reason for No Cardiac Resynchronization Therapy (CRT)

© Copyright, The Joint Commission 18 ACHF-05b Data Elements Denominator:  Birthdate  Discharge Status  E/M Code  ICD-9-CM Other Procedure Codes  ICD-9-CM Principal Diagnosis Code  ICD-9-CM Principal Procedure Code  LVEF < 35%  Optimal Medical Management For at least 3 Months

© Copyright, The Joint Commission 19 ACHF-05b Data Elements Denominator:  Outpatient Encounter Date  Reason for No Cardiac Resynchronization Therapy (CRT) in the Outpatient Setting Numerator:  Cardiac Resynchronization Therapy (CRT)

© Copyright, The Joint Commission 20 ACHF-05b Algorithm Highlights

© Copyright, The Joint Commission 21 ACHF-06a Hospital Outpatient Activity Recommendations Denominator: All heart failure patients Numerator: Outpatients who have received a document describing individualized activity recommendations tailored to their needs. This document must be present in the outpatient record

© Copyright, The Joint Commission 22 ACHF-06a Included Populations  E/M Code for hospital outpatient encounter as defined in OP Appendix A, OP Table 1.0, and  An ICD-9-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1

© Copyright, The Joint Commission 23 ACHF-06a Excluded Populations  Patients with a documented Reason for No Activity Recommendations

© Copyright, The Joint Commission 24 ACHF-06a Data Elements Denominator:  Birthdate  Discharge Status  E/M Code  ICD-9-CM Other Procedure Codes  ICD-9-CM Principal Diagnosis Code  ICD-9-CM Principal Procedure Code  Outpatient Encounter Date  Reason for No Activity Recommendations

© Copyright, The Joint Commission 25 ACHF-06a Data Elements Numerator:  Activity Recommendations Document

© Copyright, The Joint Commission 26 ACHF-06a Algorithm Highlights

© Copyright, The Joint Commission 27

© Copyright, The Joint Commission 28 Navigating the Advanced Certification Heart Failure Project Data Collection Tool

© Copyright, The Joint Commission GET STARTED Access the project website at: 29

© Copyright, The Joint Commission LOG IN TO THE PROJECT SITE 30

© Copyright, The Joint Commission 31 ADVANCED CERTIFICATION HEART FAILURE PROJECT

© Copyright, The Joint Commission ACHF PROJECT PAGE From this page you can: Access your hospital page Access the Measure and Data Element info Find data submission dates Submit questions and provide feedback Find news, tools and other resources that may become available during the project

© Copyright, The Joint Commission 33 YOUR HOSPITAL PAGE From this page you can:  Add or update your hospital information  Enter new records  View and update existing records  Mark records as “complete”  Review records that have been completed  Identify records that have been flagged for re-abstraction

© Copyright, The Joint Commission 34 Updating Hospital Demographic Information

© Copyright, The Joint Commission 35 Updating Hospital Demographic Information

© Copyright, The Joint Commission 36 Entering New Records

© Copyright, The Joint Commission 37 View and update existing records Click the Pencil icon to “Edit” an existing record Click the UBCI number to “expand” an existing record

© Copyright, The Joint Commission 38 Mark records as complete Click the empty box to “Complete” and “Lock” a record

© Copyright, The Joint Commission 39 Review records that have been completed Click the “Complete” radio button and then click “Filter” to view completed records

© Copyright, The Joint Commission 40 Identify records flagged for re-abstraction The “Lock” icon means the record is complete. The blue flag icon means the record will be re-abstracted.

© Copyright, The Joint Commission 41 ENTERING NEW RECORDS Note: hovering over the green ‘i’ next to a data element will show you the question and allowable values associated with that data element. Clicking on the green ‘i’ will link to the data element page.

© Copyright, The Joint Commission 42 ENTERING NEW RECORDS Once you have completed data entry for this record, save the data record.

© Copyright, The Joint Commission 43 DATA ENTRY CASE SCENARIOS general patient data elements Blue arrows show elements used by Inpatient and Green arrows Outpatient. Red arrows show elements used by both Inpatient and Outpatient.

© Copyright, The Joint Commission 44 general patient data elements Red arrows show elements used by both Inpatient and Outpatient. Blue arrows show elements used by Inpatient and Green arrows Outpatient.

© Copyright, The Joint Commission INPATIENT SECTION All elements from ‘Bisoprolol’ down to ‘Post-Discharge’ are Inpatient only. If Inpatient record, please fill in ALL elements. If an Outpatient record – you can leave all Inpatient elements blank

© Copyright, The Joint Commission 46 OUTPATIENT SECTION All elements from ‘Bisoprolol in Outpatient Setting’ down to ‘Reason No Activity’ are Outpatient only. If Outpatient record, please fill in ALL elements. If an Inpatient record – you can leave all Inpatient elements blank Click “Save Data Record” when all data entry is finished for the patient

© Copyright, The Joint Commission 47 FIND EXISTING RECORDS To find a record by Unique Blinded Case Identifier (UBCI), enter the UBCI and ignore the “Complete” and “Incomplete”, then click “Filter” button.

© Copyright, The Joint Commission 48 VIEW RECORD’S DETAILS To view an existing record, click on the UBCI number. You can contract the drop down by clicking on the ‘-’or expand by clicking on the ‘+’ before the different sections.

© Copyright, The Joint Commission 49 EDIT EXISTING RECORDS To edit the “General and other patient-level data elements”, click on the pencil icon.

© Copyright, The Joint Commission 50 MARKING RECORDS AS “COMPLETE”

© Copyright, The Joint Commission 51 VIEW EXISTING RECORDS To view the complete records, check the “Complete” radio button then click “Filter” button.

© Copyright, The Joint Commission 52 REVIEWING COMPLETED RECORDS The completed records are LOCKED and can not be edited. The blue flag indicates that record will be re-abstracted.

© Copyright, The Joint Commission 53 UNLOCK A RECORD To send an request to unlock a record, click on the “lock” icon and an form will appear. In the , please briefly explain why the record needs to be unlocked (e.g., Accidentally clicked the “Complete” checkbox).

© Copyright, The Joint Commission 54 ASK A QUESTION On the ACHF project page – the very bottom has a link to ask a clinical or technical question. The FAQ table also will display the common questions.

© Copyright, The Joint Commission 55