Measure Description: Percentage of patients age ≥18 y with heart failure whose patient-reported outcome score does not decline significantly (a decrease in scores of ≥5 points for the KCCQ or an increase of ≥7 points for the MLHFQ*) during a 12-mo period
Numerator	Patients whose last score within the past 6 mo of the reporting period is not significantly worse (did not decrease by ≥5 points for the KCCQ or did not increase by ≥7 points for the MLHFQ*) than the first score in the first 6 mo of the reporting period *A clinically significant change in PROMIS-PLUS-HF is not established at the time of this writing.
Denominator	Heart failure patients age ≥18 y with at least 1 patient-reported outcome measurement in both the first and past 6 mo of the measurement period (12 mo)
Denominator Exclusions	Heart transplant LVAD
Denominator Exceptions	None
Measurement Period	12 mo
Sources of Data	Qualified EHR, QCDR, electronically or telephonically transmitted PROs
Attribution	Individual practitioner Facility
Care Setting	Outpatient
Rationale
Unlike the other measures in this measure set, this is an outcome comparable to mortality. Although using each patient as their own control minimizes some of the need for risk adjustment, this measure has been designated as a quality metric because development of adequate risk-adjustment is needed prior to use as a performance measure (accountability). Two of the disease-specific PROs (KCCQ and MLHFQ) have published thresholds for change that are considered clinically meaningful (115,116). This outcome-based measure will enable comparison of the proportion of patients in each reporting unit that are not clinically worse over a year of treatment. Given that patients are expected to decline over time, this measure is not expected to be near 100%.
Clinical Recommendation(s)
2013 ACCF/AHA heart failure clinical practice guideline (7) 1. Goals of treatment of heart failure preserved ejection fraction and heart failure reduced ejection fraction are to improve health-related quality of life and symptoms (Figure 3, 2013 ACCF/AHA guideline) (7).

ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; EHR, electronic health record; KCCQ, Kansas City Cardiomyopathy Questionnaire; LVAD, left ventricular assist device; MLHFQ, Minnesota Living with Heart Failure Questionnaire; PRO, patient-reported outcome; PROMIS-PLUS-HF, Patient-Reported Outcomes Measurement Information System-Plus-Heart Failure; QCDR, Qualified Clinical Data Registry; and QM, quality measure.