Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program.
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.
Lappé
Jason M
JM
Intermountain Health Care, LDS Hospital, Salt Lake City, Utah 84143, USA.
Muhlestein
Joseph B
JB
Lappé
Donald L
DL
Badger
Rodney S
RS
Bair
Tami L
TL
Brockman
Ruth
R
French
Thomas K
TK
Hofmann
Linda C
LC
Horne
Benjamin D
BD
Kralick-Goldberg
Susan
S
Nicponski
Nan
N
Orton
Janette A
JA
Pearson
Robert R
RR
Renlund
Dale G
DG
Rimmasch
Holly
H
Roberts
Colleen
C
Anderson
Jeffrey L
JL
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