| Title |
Functional Status Assessments for Heart Failure |
||
|---|---|---|---|
| CMS eCQM ID | CMS90v15 | CBE ID | Not Applicable |
| MIPS Quality ID | 377 | ||
| Measure Steward | Centers for Medicare & Medicaid Services (CMS) | ||
| Description | Percentage of patients 18 years of age and older with heart failure who completed initial and follow-up patient-reported functional status assessments | ||
| Measure Scoring | Proportion | ||
| Measure Type | Process | ||
| Stratification | None | ||
| Risk Adjustment | None | ||
| Rationale | Patients living with heart failure often have poor functional status and health-related quality of life, which declines as the disease progresses (Allen et al., 2012). In addition, their care is often complicated by multiple comorbidities. To assist in managing these complex patients, the American College of Cardiology Foundation and American Heart Association recommend collecting initial and repeat assessments of a patient’s function and ability to complete desired activities of daily living (Hunt et al., 2009). The American Heart Association also released scientific statements emphasizing the collection of patient-reported health status (for example, functional limitations, symptom burden, quality of life) from heart failure patients as an important means of establishing a dynamic conversation between patient and provider regarding care goals and the patient’s priorities (Allen et al., 2012; Rumsfeld et al., 2013).
The most recent update to clinical guidelines by the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America further emphasizes that better understanding of symptom burden and prognosis may improve the quality of treatment decisions. The guideline also indicates that routine assessment can facilitate population health management by identifying high-risk patients needing closer monitoring or referral to specialized centers and that patient-reported health status assessment increases the patient’s role in care, which can motivate initiation and uptake of medical therapy (Heidenreich et al., 2022). |
||
| Clinical Recommendation Statement | The American Heart Association, the American College of Cardiology, and the Heart Failure Society of America (2022): This guideline provides patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure and specifically recommends assessing patient-reported health status using a validated questionnaire to provide incremental information for patient functional status, symptom burden, and prognosis. Tools specifically recommended in the guideline are as follows:
– The Kansas City Cardiomyopathy Questionnaire or, – The Minnesota Living with Heart Failure Questionnaire – PROMIS-Plus-HF [Patient Reported Outcomes Measurement Information System Plus-Heart Failure] |
||
| Improvement Notation | Higher score indicates better quality | ||
| Definition | None | ||
| Guidance | Initial functional status assessment (FSA) and encounter: The initial FSA is an FSA that occurs within two weeks before or during an encounter, in the 180 days or more before the end of the measurement period.
Follow-up FSA: The follow-up FSA must be completed at least 30 days but no more than 180 days after the initial FSA. The same FSA instrument must be used for the initial and follow-up assessment. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
||
| Initial Population | Patients 18 years of age and older who had two outpatient encounters during the measurement period and a diagnosis of heart failure that starts any time before and continues into the measurement period | ||
| Denominator | Equals Initial Population | ||
| Denominator Exclusions | Exclude patients who are in hospice care or have a hospice care order documented during any part of the measurement period.
Exclude patients with severe cognitive impairment in any part of the measurement period. |
||
| Numerator | Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement Information System [PROMIS]-10 Global Health; PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA | ||
| Numerator Exclusions | None | ||
| Denominator Exceptions | None | ||
| Telehealth Eligible | Yes | ||
| Next Version | No Version Available | ||
| Previous Version | CMS90v14 | ||
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