An electronic order set for acute myocardial infarction is associated with improved patient outcomes through better adherence to clinical practice guidelines. Issue 3 (3rd February 2014)

• Record Type: Journal Article
• Authors: Ballesca, Manuel A.; LaGuardia, Juan Carlos; Lee, Philip C.; Hwang, Andrew M.; Park, David K.; Gardner, Marla N.; Turk, Benjamin J.; Kipnis, Patricia; Escobar, Gabriel J.
• Is Part Of: Journal of hospital medicine. Volume 9:Issue 3(2014)
• Page Start: 155
• Page End: 161
• Publication Date: 2014-02-03
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2149
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2149-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Adherence to evidence‐based recommendations for acute myocardial infarction (AMI) remains unsatisfactory.</p> </sec> <sec id="jhm2149-sec-0002" sec-type="section"> <title>OBJECTIVE</title> <p>Quantifying association between using an electronic AMI order set (AMI‐OS) and hospital processes and outcomes.</p> </sec> <sec id="jhm2149-sec-0003" sec-type="section"> <title>DESIGN</title> <p>Retrospective cohort study.</p> </sec> <sec id="jhm2149-sec-0004" sec-type="section"> <title>SETTING</title> <p>Twenty‐one community hospitals.</p> </sec> <sec id="jhm2149-sec-0005" sec-type="section"> <title>PATIENTS</title> <p>A total of 5879 AMI patients were hospitalized between September 28, 2008 and December 31, 2010.</p> </sec> <sec id="jhm2149-sec-0006" sec-type="section"> <title>MEASUREMENTS</title> <p>We ascertained whether patients were treated using the AMI‐OS or individual orders (a la carte). Dependent process variables were use of evidence‐based care; outcome variables were mortality and rehospitalization.</p> </sec> <sec id="jhm2149-sec-0007" sec-type="section"> <title>RESULTS</title> <p>Use of individual and combined therapies improved outcomes (eg, 50% lower odds of 30‐day mortality for patients with ≥3 therapies). The 3531 patients treated using the AMI‐OS were more likely to receive evidence‐based therapies (eg, 50% received 5 different therapies vs 36% a la carte). These patients had lower 30‐day mortality (5.7% vs 8.5%) than the 2348 treated using a la carte orders. Although AMI‐OS patients' predicted mortality risk was lower (3.2%) than that of a la carte patients (4.8%), the association of improved processes and outcomes with the use of the AMI‐OS persisted after risk adjustment. For example, after inverse probability weighting, the relative risk for inpatient mortality in the AMI‐OS group was 0.67 <italic>(</italic>95% confidence interval: 0.52‐0.86<italic>)</italic>. Inclusion of use of recommended therapies in risk adjustment eliminated the benefit of the AMI‐OS, highlighting its mediating effect on adherence to evidence‐based treatment.</p> </sec> <sec id="jhm2149-sec-0008" sec-type="section"> <title>CONCLUSIONS</title> <p>Use of an electronic order set is associated with increased adherence to evidence‐based care and better AMI outcomes. <italic>Journal of Hospital Medicine</italic> 2014;9:155–161. © 2014 Society of Hospital Medicine</p> </sec> </abstract>