ACEi/ARB for systolic heart failure: Closing the quality gap with a sustainable intervention at an academic medical center

Qi Qian, Dennis M. Manning, Narith Ou, Mark J. Klarich, Dorinda J. Leutink, Ann R. Loth, Francisco Lopez-Jimenez

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

National guidelines recommend angiotensin converting enzyme inhibitor (ACEi) or angiotensinogen receptor blocker (ARB) therapy for patients with left ventricular systolic dysfunction (LVSD), including those with symptomatic heart failure (HF). However, guideline adherence has not been optimal. The goal of this quality improvement project is to devise and implement a sustainable care-delivery model in a 920-bed academic hospital center that would improve ACEi/ARB adherence before hospital discharge. +METHODS:: The Model of intervention is: (1) a computer-based daily screening program; (2) inpatient pharmacist e-flag message; and (3) alerts for inpatient care teams. Its operating algorithm: If eligible adult HF/LVSD inpatients are not on ACEi or ARB nor documentation of contraindications, a flag alert is generated; deficiency is confirmed by a pharmacist and conveyed to the patient-care teams; if alert is acted on and care brought into adherence, the screening program would not re-flag the same patients the succeeding day; if not, the patients would be re-flagged daily until reaching adherence. We compared ACEi/ARB adherence before, during, and after the intervention. +RESULTS:: Baseline performance (percentage of eligible HF/LVSD patients receiving ACEi/ARB) was 87.5%. After implementation of the Model the ACEi/ARB adherence rate at the time of hospital discharge rose to 96.7% (P < 0.002) and was sustained for 21 months without needing additional personnel. +CONCLUSIONS:: A carefully designed, computer-based care-delivery model is highly efficient and sustainable for enhancing ACEi/ARB adherence.

Original languageEnglish (US)
Pages (from-to)156-160
Number of pages5
JournalJournal of Hospital Medicine
Volume6
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Systolic Heart Failure
Angiotensinogen
Angiotensin-Converting Enzyme Inhibitors
Left Ventricular Dysfunction
Inpatients
Heart Failure
Pharmacists
Guideline Adherence
Patient Care Team
Quality Improvement
Documentation
Guidelines

Keywords

  • ACEi/ARB guidelines
  • Adherence
  • Computer-based model
  • Cost
  • Heart failure
  • Quality improvement

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

ACEi/ARB for systolic heart failure : Closing the quality gap with a sustainable intervention at an academic medical center. / Qian, Qi; Manning, Dennis M.; Ou, Narith; Klarich, Mark J.; Leutink, Dorinda J.; Loth, Ann R.; Lopez-Jimenez, Francisco.

In: Journal of Hospital Medicine, Vol. 6, No. 3, 03.2011, p. 156-160.

Research output: Contribution to journalArticle

Qian, Qi ; Manning, Dennis M. ; Ou, Narith ; Klarich, Mark J. ; Leutink, Dorinda J. ; Loth, Ann R. ; Lopez-Jimenez, Francisco. / ACEi/ARB for systolic heart failure : Closing the quality gap with a sustainable intervention at an academic medical center. In: Journal of Hospital Medicine. 2011 ; Vol. 6, No. 3. pp. 156-160.
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