Improved compliance with quality measures at hospital discharge with a computerized physician order entry system

Butler, Javed; Speroff, Theodore; Arbogast, Patrick G.; Newton, Martha; Waitman, Lemuel R.; Stiles, Renee; Miller, Randolph A.; Ray, Wayne; Griffin, Marie R.

doi:10.1016/j.ahj.2005.05.007

« Previous Next »American Heart Journal
Volume 151, Issue 3 , Pages 643-653, March 2006

Improved compliance with quality measures at hospital discharge with a computerized physician order entry system

Javed Butler, MD, MPH
- Department of Medicine, Cardiology Division, Vanderbilt University, Nashville VAMC, Nashville, TN
- Center for Health Services Research, Vanderbilt University, Nashville VAMC, Nashville, TN
- Center for Education and Research in Therapeutics, Nashville VAMC, Nashville, Tenn
- Reprint requests: Javed Butler, MD, Cardiology Division, 383-PRB, Vanderbilt University Medical Center, Nashville, TN 37232-6300.
Theodore Speroff, PhD
- Center for Health Services Research, Vanderbilt University, Nashville VAMC, Nashville, TN
- Geriatrics Research, Education, and Clinical Center, Nashville VAMC, Nashville, TN
- Tennessee Valley Health Services Research Center, Tennessee Valley Health Care System, Nashville VAMC, Nashville, TN
Patrick G. Arbogast, PhD
- Department of Biostatistics, Vanderbilt University, Nashville VAMC, Nashville, TN
- Department of Preventive Medicine, VanderbiltUniversity, Nashville VAMC, Nashville, TN
- Center for Education and Research in Therapeutics, Nashville VAMC, Nashville, Tenn
Martha Newton, MS
- Center for Clinical Improvement, Vanderbilt University, Nashville VAMC, Nashville, TN
Lemuel R. Waitman, PhD
- Department of Biomedical Informatics, Vanderbilt University, Nashville VAMC, Nashville, TN
Renee Stiles, PhD
- Center for Clinical Improvement, Vanderbilt University, Nashville VAMC, Nashville, TN
- Geriatrics Research, Education, and Clinical Center, Nashville VAMC, Nashville, TN
- Tennessee Valley Health Services Research Center, Tennessee Valley Health Care System, Nashville VAMC, Nashville, TN
Randolph A. Miller, MD
- Department of Biomedical Informatics, Vanderbilt University, Nashville VAMC, Nashville, TN
Wayne Ray, PhD
- Center for Health Services Research, Vanderbilt University, Nashville VAMC, Nashville, TN
- Department of Preventive Medicine, VanderbiltUniversity, Nashville VAMC, Nashville, TN
- Center for Education and Research in Therapeutics, Nashville VAMC, Nashville, Tenn
- Geriatrics Research, Education, and Clinical Center, Nashville VAMC, Nashville, TN
- Tennessee Valley Health Services Research Center, Tennessee Valley Health Care System, Nashville VAMC, Nashville, TN
Marie R. Griffin, MD, MPH
- Center for Health Services Research, Vanderbilt University, Nashville VAMC, Nashville, TN
- Department of Preventive Medicine, VanderbiltUniversity, Nashville VAMC, Nashville, TN
- Center for Education and Research in Therapeutics, Nashville VAMC, Nashville, Tenn
- Geriatrics Research, Education, and Clinical Center, Nashville VAMC, Nashville, TN
- Tennessee Valley Health Services Research Center, Tennessee Valley Health Care System, Nashville VAMC, Nashville, TN

Received 13 November 2004; accepted 9 May 2005.

This study was supported in part by the Agency for Healthcare Research and Quality, Centers for Education and Research in Therapeutics cooperative agreement (grant HS 1-0384), and a cooperative agreement with the Food and Drug Administration (FD-U-001641).

Background

Most measures used to assess the quality of care of hospitalized patients with congestive heart failure (CHF) and acute myocardial infarction (AMI) involve discharge medications and instructions. Implementation of disease-specific computerized physician order entry (CPOE) discharge tools may improve compliance with these measures.

Methods

We studied 286 versus 290 AMI and 595 versus 656 CHF discharges in the pre-CPOE (July 20001 to June 2002) and CPOE (October 2002 to September 2003) periods, respectively. Compliance with chosen quality measures (aspirin and β-blocker use for AMI, ejection fraction determination and discharge instructions for CHF, and angiotensin-converting enzyme inhibitor use, and smoking cessation counseling for both) was assessed.

Results

Compliance with recommended discharge medications was high at baseline and did not change significantly. Smoking cessation counseling (43% vs 1% for CHF and 62% vs 21% for AMI) and discharge instructions for CHF (56% vs 3%) improved significantly in the CPOE period. Overall, 63% of patients with CHF and AMI in the CPOE period were discharged using the tools. Compliance with prescription of recommended medications was 100% among eligible patients when CPOE was used; however, this improvement was due entirely to better documentation of contraindications in the CPOE period. The actual proportion of patients who received discharge prescriptions between the pre-CPOE and CPOE periods did not change: β-blockers (85% vs 84%), angiotensin-converting enzyme inhibitor for AMI (77% vs 76%), and for CHF (56% vs 61%). However, nonmedication measures significantly improved when CPOE was used.

Conclusions

Implementation of a CPOE discharge tool improved compliance with selected quality measures in patients with AMI and CHF. Effective methods of rapid implementation and acceptance of these tools by providers require further study.