Patient-reported Measures: KCCQ and CHF outcomes Aanand D. Naik, MD Houston Health Services Research and Development Center of Excellence

Patient-Centered Care Institute of Medicine Framework – “Crossing the Quality Chasm” – Framework for defining quality and safety Patient-Centered Care – Healthcare that established a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.

Standards for PCC “Nothing about me without me” The right care in the right way at the right time Providing the care that the patient needs in the manner the patient desires at the time the patient desires Picker Institute

More than marketing slogan Not simply a touchy-feeling endorsement of patients Not about clean offices, short waiting times, or nicer hospital meals – More than a marketing slogan Patient-centered care – Improves health outcomes – Enhances health care quality and safety

How do you make this happen 1.Develop and validate measures – Take patients’ perspective of illness – Link that perspective to: Diagnosis Treatment Clinical change Objective outcomes 2.Allow patients to define the nature and experience of clinical outcomes

Patient-oriented measures & outcomes Scales that define processes of care or clinical outcomes Subjective in nature – Patients answer them from their perspective – Items are understandable, personally meaningful Psychometrically reliable and valid Correlated to other objective outcomes

Congestive Heart Failure CHF is a common clinical syndrome especially among older adults – Chronic condition without a cure – Enormous impact on the prognosis and lifestyle of patients Furthermore, it is a chronic condition Goals of Treatment – Preventing disease progression (deterioration of heart function, avoiding hospitalization) – Alleviating patient suffering Patient reported measures can – Help measure and reduce patients symptoms/suffering – Correlated with disease progression

Kansas City Cardiomyopathy Questionnaire (KCCQ) a self-administered, 23-item questionnaire Describes CHF specific quality of life Quantifies (subscales): – Physical limitation, – Symptoms (frequency, severity, change over time) – Subjective QoL – Social interference and – Self-efficacy.

KCCQ Psychometrics Reliable measure of stable CHF Responsive to change in decompensated pts Subscales correlated with: – NYHA classification, SF-36, 6-minute walk scores – Convergent validation (JACC 2000) Predictive validity – Predicts 1 year cardiovascular mortality and hospitalization (Circulation 2004)

Depression and KCCQ Multicenter study evaluating baseline depression with 6 week change in KCCQ scores – 30% of CHF patients had depression MOS-depression scores – Depression associated with lower KCCQ at baseline (47.7 vs 67.3, p<.001) – Depressed patients had an average change score over 6 weeks of (-7.1, p<.001) (JACC 2003)

Summary KCCQ is a clinically important, patient-report measure specific to heart failure Correlates with disease severity and predictive of objective, clinical outcomes Depression highly linked with CHF outcomes Depressed patients have lower KCCQ scores and depressive predicts worsening of KCCQ