Recommendation 176: We recommend that health care systems should provide for quality assurance in both the process and content of care provision (Strong Recommendation, High Quality Evidence).
Recommendation 177: We recommend that quality assurance programs should include elements listed below to allow for assessment of patient, provider and health care institutional outcomes (Strong Recommendation, Moderate Quality Evidence):
- Measurement of evidence-based key performance indicators to assess system performance and outcomes.
- Robust measurement of important clinical and system of care outcomes.
- Intervention supports such as clinical tools to facilitate best practices.
- Performance feedback and education to HF care professionals and administrators.
Practical tips:
- Selection of performance indicators with outcome data from randomized clinical trials, such as those listed in the CCS Quality Indicators E- Library- Heart Failure, is preferred.
- Institutional quality improvement strategies that include the following features have been shown to improve outcomes:
- Reliance on a set of multi-modal rather than single interventions
- Administrative and change management support
- Provision of quality assurance personnel support
- Emphasis on persistent/sustainable rather than temporary interventions
- Resource support, during and following the period of practice change
- Both administrative and physician champions
- It is unclear if any single intervention is superior to another. Use of multiple simultaneous interventions provides a larger effect size.
- Examples of interventions with the highest quality of evidence for outcome improvement at a system level include:
- Use of therapies proven to improve clinical outcomes in randomized clinical trials
- Interdisciplinary and longitudinal approach to chronic disease care including with repeated visits, case management, home visits and multimodal communication methods
- Comprehensive hospital and post- acute care in combination
- Timely and accurate communication between health care providers
- Examples of isolated interventions with limited evidence for improved process measure outcome improvement at a system level include:
- Practice audits with multifaceted feedback
- Reminder or decision support tools
- Health care provider education
- Patient/family education
- Pay for performance programs
- Telemedicine/Telemonitoring programs
- Broader regional, provincial and national frameworks are required to promote and facilitate quality assurance initiatives at all levels of HF care.