title: 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.
authors.affiliation: Cardiology Division, Department of Medicine, Vanderbilt University, VAMC, Nashville, TN, USA. javed.butler@vanderbilt.edu
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Martha
authors.initials: M
authors.lastname: Newton
authors.forename: Lemuel R
authors.initials: LR
authors.lastname: Waitman
authors.forename: Renee
authors.initials: R
authors.lastname: Stiles
authors.forename: Randolph A
authors.initials: RA
authors.lastname: Miller
authors.forename: Wayne
authors.initials: W
authors.lastname: Ray
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D016507:Cardiology Service, Hospital / Q000592:standards*; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D050316:Medical Order Entry Systems / Q000458:organization & administration; D009203:Myocardial Infarction / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D013714:Tennessee