title: Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program.
abstract: BACKGROUND
  Despite recent advances in the treatment and prevention of cardiovascular disease, a treatment gap for secondary prevention medications still exists.
  
  
  OBJECTIVE
  To develop and implement a program ensuring appropriate prescription of aspirin, statins, beta-blockers, angiotensin-converting enzyme inhibitors, and warfarin at hospital discharge.
  
  
  METHODS
  A nonrandomized before-after study comparing patients hospitalized before (1996-1998) and after (1999-2002) implementation of a discharge medication program (DMP). Patients were followed for up to 1 year.
  
  
  METHODS
  The 10 largest hospitals in the Utah-based Intermountain Health Care system.
  
  
  METHODS
  In the pre-DMP and DMP time periods, 26,000 and 31,465 patients, respectively, were admitted to cardiovascular services (n = 57,465).
  
  
  METHODS
  Prescription of indicated medications at hospital discharge; postdischarge death or readmission.
  
  
  RESULTS
  By 1 year, the rate of prescription of each medication increased significantly to more than 90% (P < 0.001); this rate was sustained. At 1 year, unadjusted absolute event rates for readmission and death, respectively, were 210 per 1000 person-years and 96 per 1000 person-years before DMP implementation and 191 per 1000 person-years and 70 per 1000 person-years afterward. Relative risk for death and readmission at 30 days decreased after DMP implementation; hazard ratios (HRs) for death and readmission were 0.81 (95% CI, 0.73 to 0.89) and 0.92 (CI, 0.87 to 0.99) (P < 0.001 and P = 0.017, respectively). At 1 year, risk for death continued to decrease (hazard ratio, 0.79 [CI, 0.75 to 0.84]; P < 0.001) while risk for readmission stabilized (hazard ratio, 0.94 [CI, 0.90 to 0.98]; P = 0.002), probably because survivors had more opportunities to be readmitted.
  
  
  CONCLUSIONS
  The study design was observational and nonrandomized, and the authors could not control for potential confounders or determine the extent to which secular trends accounted for the observed improvements.
  
  
  CONCLUSIONS
  A relatively simple quality improvement program aimed at enhancing the prescription of appropriate discharge medications among cardiovascular patients is feasible and can be sustained within an integrated multihospital system. Such a program may be associated with improvements in cardiovascular readmission rates and mortality.
authors.affiliation: Intermountain Health Care, LDS Hospital, Salt Lake City, Utah 84143, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Lappé
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: Donald L
authors.initials: DL
authors.lastname: Lappé
authors.forename: Rodney S
authors.initials: RS
authors.lastname: Badger
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.forename: Ruth
authors.initials: R
authors.lastname: Brockman
authors.forename: Thomas K
authors.initials: TK
authors.lastname: French
authors.forename: Linda C
authors.initials: LC
authors.lastname: Hofmann
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.forename: Susan
authors.initials: S
authors.lastname: Kralick-Goldberg
authors.forename: Nan
authors.initials: N
authors.lastname: Nicponski
authors.forename: Janette A
authors.initials: JA
authors.lastname: Orton
authors.forename: Robert R
authors.initials: RR
authors.lastname: Pearson
authors.forename: Dale G
authors.initials: DG
authors.lastname: Renlund
authors.forename: Holly
authors.initials: H
authors.lastname: Rimmasch
authors.forename: Colleen
authors.initials: C
authors.lastname: Roberts
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy*; D011307:Drug Prescriptions; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010351:Patient Discharge; D015397:Program Evaluation