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J Hosp Med. 2014 Mar;9(3):155-61. doi: 10.1002/jhm.2149. Epub 2014 Feb 3.

An electronic order set for acute myocardial infarction is associated with improved patient outcomes through better adherence to clinical practice guidelines.

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1
Kaiser Permanente Information Technology, Pleasanton, California.

Abstract

BACKGROUND:

Adherence to evidence-based recommendations for acute myocardial infarction (AMI) remains unsatisfactory.

OBJECTIVE:

Quantifying association between using an electronic AMI order set (AMI-OS) and hospital processes and outcomes.

DESIGN:

Retrospective cohort study.

SETTING:

Twenty-one community hospitals.

PATIENTS:

A total of 5879 AMI patients were hospitalized between September 28, 2008 and December 31, 2010.

MEASUREMENTS:

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.

RESULTS:

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 (95% confidence interval: 0.52-0.86). 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.

CONCLUSIONS:

Use of an electronic order set is associated with increased adherence to evidence-based care and better AMI outcomes.

PMID:
24493376
DOI:
10.1002/jhm.2149
[Indexed for MEDLINE]
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