Improved compliance with quality measures at hospital discharge with a computerized physician order entry system

Abstract

Background: Most measures used to assess the quality of care of hospitalized patients with congestive heart failure (CHF) and acute myocardial infarction (AMI) involve discharge medications and instructions. Implementation of disease-specific computerized physician order entry (CPOE) discharge tools may improve compliance with these measures.

Methods: We studied 286 versus 290 AMI and 595 versus 656 CHF discharges in the pre-CPOE (July 2001 to June 2002) and CPOE (October 2002 to September 2003) periods, respectively. Compliance with chosen quality measures (aspirin and beta-blocker use for AMI, ejection fraction determination and discharge instructions for CHF, and angiotensin-converting enzyme inhibitor use, and smoking cessation counseling for both) was assessed.

Results: Compliance with recommended discharge medications was high at baseline and did not change significantly. Smoking cessation counseling (43% vs 1% for CHF and 62% vs 21% for AMI) and discharge instructions for CHF (56% vs 3%) improved significantly in the CPOE period. Overall, 63% of patients with CHF and AMI in the CPOE period were discharged using the tools. Compliance with prescription of recommended medications was 100% among eligible patients when CPOE was used; however, this improvement was due entirely to better documentation of contraindications in the CPOE period. The actual proportion of patients who received discharge prescriptions between the pre-CPOE and CPOE periods did not change: beta-blockers (85% vs 84%), angiotensin-converting enzyme inhibitor for AMI (77% vs 76%), and for CHF (56% vs 61%). However, nonmedication measures significantly improved when CPOE was used.

Conclusions: Implementation of a CPOE discharge tool improved compliance with selected quality measures in patients with AMI and CHF. Effective methods of rapid implementation and acceptance of these tools by providers require further study.