Measure description: Percentage of outpatients age ≥18 y with a diagnosis of heart failure who have a disease-specific patient-reported health status measurement recorded within each 6-mo period
Numerator	Patients with a disease-specific PRO reported in the medical record during a 6-mo period
Denominator	All patients age ≥18 y with a diagnosis of heart failure
Denominator Exclusions	Heart transplant LVAD
Denominator Exceptions	Documentation of medical reason(s) for not reporting a disease-specific, patient-reported health status measurement (e.g., severe cognitive or functional impairment) Documentation of patient reason(s) for not reporting a disease-specific, patient-reported health status measurement
Measurement Period	12 mo with at least 1 PRO reported in each 6 mo of the reporting cycle
Sources of Data	EHR data Clinical registry
Attribution	Individual practitioner Facility
Care Setting	Outpatient
Rationale
A fundamental goal of treating patients with heart failure is to improve symptoms, which is most accurately quantified by directly asking them. Disease-specific PROs (e.g., MLHFQ or KCCQ) are recommended as they are more sensitive to clinical change in heart failure than general health status measures. PROs are also predictive of other outcomes such as mortality, hospitalization, and costs (109–111) and often vary by sex, race/ethnicity, and socioeconomic status (112,113). Knowledge of a patient’s reported health status may prompt changes in medications that will further improve care (114). There are multiple disease-specific tools that have been developed to capture PROs in heart failure. The ACC/AHA have not addressed PRO tool selection. However, the FDA has provided guidelines for an appropriate PRO tool (16) and, currently, 2 heart failure survey tools–the MLHFQ (15) and the KCCQ (14)–are considered qualified tools for FDA device use in heart failure (17). As a process measure for capturing a clinically important outcome, no risk-adjustment methods are required. It is required as a foundation for outcomes-based performance measure and is paired with QM-3.
Clinical Recommendation(s)
2013 ACCF/AHA heart failure clinical practice guideline (7) 1. The ACC/AHA heart failure guideline modifies several recommendations based on the health status of the patient, usually quantified by the NYHA classification (7).

ACC indicates American College of Cardiology; ACCF, American College of Cardiology Foundation; AHA, American Heart Association; EHR, electronic health record; FDA, U. S. Food and Drug Administration; KCCQ, Kansas City Cardiomyopathy Questionnaire; LVAD, left ventricular assist device; MLHFQ, Minnesota Living with Heart Failure Questionnaire; NYHA, New York Heart Association; PRO, patient-reported outcome; and QM, quality measure.