In 2004, the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission (JC) determined a standard set of discharge instructions must be provided to patients with a principle diagnosis of congestive heart failure (CHF). Compliance with the core measure HF‐1 metric requires that activity, diet, follow‐up, worsening symptoms, weight monitoring, and a reconciled list of discharge medications must be documented in the medical record, as provided to the patient at the lime of discharge. Compliance at our institution regressed from 76% to 39% in the latter part of 2005, when reconciliation of discharge medications was added to the abstraction criteria. Drill down on outliers confirmed the lack of accurate medication reconciliation as the exclusive driver of noncompliance in 49% of the cases abstracted between July and December 2006.
Our institution moved from a paper medication reconciliation process to a homegrown electronic process in August 2009. The purpose of this review is to demonstrate the positive impact eMed Rec has had on the HF‐1 core measure metric.
Our Quality Department routinely abstracts core measure metrics. To diagnose errors and improve performance on these measures we conduct a monthly analysis of outliers Findings are presented to a mullidisciplinary performance improvement team charged with improving our internal processes and publicly reported scores. We compared a pre‐eMed Rec implementation sample of CHF charts abstracted between July and December 2006 to a post‐eMed Rec sample, July‐September 2009. A case delect is defined as any case in the HF‐1 sample without documentation that written in structions meeting all 6 required HF‐1 elements (activity; diet, follow‐up. worsening symptoms, weight monitoring, and a reconciled list of discharge medications) were provided to the patient at discharge. There are 6 defect opportunities for each case in the sample. Of the 126 eligible cases in July‐December 2006, (Fig. 1), medication reconciliation was confirmed as the exclusive driver of noncompliance in 49% (34 of 70 defective cases). By comparison, abstraction of recent third‐quarter 2009 data (Fig. 2), 68 eligible cases, showed medication reconciliation as the primary driver of noncompliance in 11 % (2 of 18 defective cases), P < 0.01.
Moving from an ineffective paper process to an electronic system compatible with work flow has demonstrated a significant improvement in our publicly reported HF‐1 core measure scores.
L. Finkelstein‐Blond, none; J. Goldenberg, none; V. Aquino, none; M. Fradis, none: J. Kalman, none; J. Kannry, none; D. Mendelson, none.
To cite this abstract:Finkelstein‐Blond L, CIC , Goldenberg J, Aquino V, Fradis M, Mendelson D, Kannry J, Kalman J. Electronic Medication Reconciliation (eMed Rec) Improves Compliance with the HF‐1 Core Measure Metric. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 163. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/electronic-medication-reconciliation-emed-rec-improves-compliance-with-the-hf1-core-measure-metric/. Accessed May 26, 2019.