title: Designing a comprehensive strategy to improve one core measure: discharge of patients with myocardial infarction or heart failure on ACE inhibitors/ARBs.
abstract: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEs/ARBs) have proven benefit for patients with myocardial infarction and heart failure; their use is a core measure of hospital quality for the Centers for Medicare and Medicaid Services. The authors' urban medical center has lower-than-average performance on this measure. The authors used published best practices to design and implement a comprehensive strategy to improve ACE/ARB performance with existing decision support and human resources. Chart reminders were targeted to providers of patients eligible for ACEs/ARBs but not receiving them. ACE/ARB performance increased 8.5% in postintervention patients compared with historical controls. The increase was 20.7% among patients not on ACEs/ARBs on admission (P =.03). Chronic kidney disease (CKD) was inversely associated with the effectiveness of the intervention. A comprehensive strategy can be effective in narrowing the performance gap even for populations with a high prevalence of CKD. However, future work is needed to improve performance among patients whose ACEs/ARBs are withheld during hospitalization.
authors.affiliation: Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. casantan@montefiore.org
authors.forename: Calie
authors.initials: C
authors.lastname: Santana
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaines
authors.forename: Peter
authors.initials: P
authors.lastname: Choi
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhalla
mesh_terms: D000046:Academic Medical Centers / Q000379:methods / Q000592:standards; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy*; D009519:New York City; D010351:Patient Discharge / Q000592:standards*; D017064:Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000209:etiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors