title: Decline in ACEI/ARB Prescribing as Heart Failure Core Metrics Improve During Computer-Based Clinical Decision Support.
abstract: Computer-based clinical decision-support systems are effective interventions to improve compliance with guidelines and quality measures. However, understanding of their long-term impact, including unintended consequences, is limited. The authors assessed the clinical impact of the sequential implementation of 2 such systems to improve the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) in inpatients with heart failure. Compliance with the core measure improved from 91.0% at baseline to 93.6% with the Pharmacy Care (P-Care) Rule and to 96.4% with the Centricity-Blaze (CE-Blaze) Rule. At the same time, prescriptions for ACEIs/ARBs documented in the hospital discharge summary decreased from 83.2% at baseline to 75.8% with the P-Care rule and to 64.1% with the CE-Blaze Rule. The inpatient mortality rate and the 30-day readmission rate did not change significantly. Better documentation of contraindications in the electronic medical record seems to account for the core measure improvement, even as ACEI/ARB therapy has unexpectedly declined.
authors.affiliation: Mayo Clinic, Rochester, MN caraballo.pedro@mayo.edu.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Caraballo
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Klarich
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Dorinda J
authors.initials: DJ
authors.lastname: Leutink
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: James A
authors.initials: JA
authors.lastname: Peterson
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagie
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Manning
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Qi
authors.initials: Q
authors.lastname: Qian
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D020000:Decision Support Systems, Clinical; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: core measures; decision support; heart failure; quality