The impact of achieving perfect care in acute coronary syndrome: the role of computer assisted decision support.
BACKGROUND
Attainment of every performance measure or perfect care (PC) is used as a tool for measuring hospital quality of care. We sought to describe the effect of achieving PC on subsequent outcomes in patients admitted with acute coronary syndrome (ACS) and to determine whether computerized physician order entry enabled with decision support (CPOE-DS) would enhance the likelihood of achieving PC and improvements in clinical outcomes.


METHODS
Clinical inpatient data, performance measures and subsequent mortality was collected in 1,321 consecutive ACS patients admitted between January 1, 2009, to October 15, 2011, using either a standardized order set that followed consensus guidelines or orders generated via CPOE-DS.


RESULTS
CPOE-DS generated orders were utilized in 642 (49%) patients while the remaining 679 (51%) of patients were admitted using standardized order sets. At baseline, CPOE-DS patients were younger (-3%, P = .006), had lower resting heart rates (-3%, P = .012), higher TIMI risk scores (+19%, P < .001), were less likely to have hypertension (85% vs. 90%, P = .014), and more likely to have ST-segment elevation myocardial infarction (17% vs 10%; P = .001) than patients admitted with standard orders. Patients admitted using CPOE-DS were 5.7 times more likely to achieve PC than those who were admitted with standard orders (P < .001). Independent predictors of survival included PC (HR, 0.45; P < .001), age ≥67 years (HR, 2.34; P < .001), and abnormal presenting heart rate (HR, 1.71; P = .046).


CONCLUSIONS
Achievement of PC is a valid measure of quality of care in the hospitalized ACS patient and is associated with improved survival. CPOE-DS is feasible in the care process for ACS and can increase attainment of PC.
Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA. rmilani@ochsner.org
Richard V
RV
Milani
Carl J
CJ
Lavie
Adriana C
AC
Dornelles
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003658:Decision Making, Computer-Assisted; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult