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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 300-307 |
| Number of pages | 8 |
| Journal | American Journal of Medical Quality |
| Volume | 29 |
| Issue number | 4 |
| DOIs | |
| State | Published - 2014 |
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Keywords
- core measures
- decision support
- heart failure
- quality
ASJC Scopus subject areas
- Health Policy
Cite this
Decline in ACEI/ARB Prescribing as Heart Failure Core Metrics Improve During Computer-Based Clinical Decision Support. / Caraballo, Pedro; Naessens, James M; Klarich, Mark J.; Leutink, Dorinda J.; Peterson, James A.; Wagie, Amy E.; Manning, Dennis M.; Qian, Qi.
In: American Journal of Medical Quality, Vol. 29, No. 4, 2014, p. 300-307.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Decline in ACEI/ARB Prescribing as Heart Failure Core Metrics Improve During Computer-Based Clinical Decision Support
AU - Caraballo, Pedro
AU - Naessens, James M
AU - Klarich, Mark J.
AU - Leutink, Dorinda J.
AU - Peterson, James A.
AU - Wagie, Amy E.
AU - Manning, Dennis M.
AU - Qian, Qi
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
KW - core measures
KW - decision support
KW - heart failure
KW - quality
UR - http://www.scopus.com/inward/record.url?scp=84904284274&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84904284274&partnerID=8YFLogxK
U2 - 10.1177/1062860613509265
DO - 10.1177/1062860613509265
M3 - Article
C2 - 24249835
AN - SCOPUS:84904284274
VL - 29
SP - 300
EP - 307
JO - American Journal of Medical Quality
JF - American Journal of Medical Quality
SN - 1062-8606
IS - 4
ER -