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To determine whether the use of an electronic discharge orders tool was correlated with higher adherence to core measures and lower hospital readmissions.
Despite increased used of standardized discharge orders and evidence suggesting the effectiveness of these tools, little is known about adherence to core measures and 30-day all-cause hospital readmission among patients discharged with these electronic systems.
A retrospective study was conducted on heart failure (HF) patients discharged from Intermountain Healthcare hospitals between January 2011 and September 2012. The primary outcome was 30-day all-cause readmissions as defined by The Centers for Medicare & Medicaid Services. Adherence to HF core measures was evaluated on three inpatient quality measures. Adult smoking cessation advice/counseling was excluded as it is a non[[Unable to Display Character: ‐]]accountability measure. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals.
A total of 2,409 encounters were found eligible to adhere to at least one core measure. The discharge orders tool was used in slightly over half (55%) of these encounters. Full adherence to HF quality measures was higher among patients discharged with the electronic tool (OR = 9.89; 95% CI = 6.08 – 16.11). The observed readmission rate among patients discharged with and without the electronic discharge orders tool was 15.5% and 18.0%, respectively. After adjusting for length of stay, age, sex, and severity of illness we found that the likelihood of readmission was lower (OR = 0.77; CI = 0.62 – 0.97) among patients discharged with the electronic tool.
The use of an electronic discharge orders tool enhanced with decision support algorithms aimed at increasing the prescription of evidence-based discharge medications and the provision of HF instructions was associated with increased compliance with HF core measures and with lower readmission rates among heart failure patients.
West, Room 3006
Sunday, March 10, 2013, 11:45 a.m.-Noon
Session Title: How Outcomes Research Impacts Care
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 929-7
- 2013 American College of Cardiology Foundation