Decline in ACEI/ARB Prescribing as Heart Failure Core Metrics Improve During Computer-Based Clinical Decision Support. (July 2014)

• Record Type: Journal Article
• Authors: Caraballo, Pedro J.; Naessens, James M.; Klarich, Mark J.; Leutink, Dorinda J.; Peterson, James A.; Wagie, Amy E.; Manning, Dennis M.; Qian, Qi
• Is Part Of: American journal of medical quality. Volume 29:Number 4(2014:Jul./Aug.)
• Page Start: 300
• Page End: 307
• Publication Date: 2014-07
• Subjects: heart failure -- decision support -- quality -- core measures; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860613509265
• Languages: English
• ISSNs: 1062-8606

Abstract

Computer-based clinical decision-support systems are effective interventions to improve compliance with guidelines and quality measures. However, understanding of their long-term impact, including unintended consequences, is limited. The authors assessed the clinical impact of the sequential implementation of 2 such systems to improve the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) in inpatients with heart failure. Compliance with the core measure improved from 91.0% at baseline to 93.6% with the Pharmacy Care (P-Care) Rule and to 96.4% with the Centricity-Blaze (CE-Blaze) Rule. At the same time, prescriptions for ACEIs/ARBs documented in the hospital discharge summary decreased from 83.2% at baseline to 75.8% with the P-Care rule and to 64.1% with the CE-Blaze Rule. The inpatient mortality rate and the 30-day readmission rate did not change significantly. Better documentation of contraindications in the electronic medical record seems to account for the core measure improvement, even as ACEI/ARB therapy has unexpectedly declined.