An electronic order set for acute myocardial infarction is associated with improved patient outcomes through better adherence to clinical practice guidelines.
BACKGROUND
Adherence to evidence-based recommendations for acute myocardial infarction (AMI) remains unsatisfactory.


OBJECTIVE
Quantifying association between using an electronic AMI order set (AMI-OS) and hospital processes and outcomes.


METHODS
Retrospective cohort study.


METHODS
Twenty-one community hospitals.


METHODS
A total of 5879 AMI patients were hospitalized between September 28, 2008 and December 31, 2010.


METHODS
We ascertained whether patients were treated using the AMI-OS or individual orders (a la carte). Dependent process variables were use of evidence-based care; outcome variables were mortality and rehospitalization.


RESULTS
Use of individual and combined therapies improved outcomes (eg, 50% lower odds of 30-day mortality for patients with ≥3 therapies). The 3531 patients treated using the AMI-OS were more likely to receive evidence-based therapies (eg, 50% received 5 different therapies vs 36% a la carte). These patients had lower 30-day mortality (5.7% vs 8.5%) than the 2348 treated using a la carte orders. Although AMI-OS patients' predicted mortality risk was lower (3.2%) than that of a la carte patients (4.8%), the association of improved processes and outcomes with the use of the AMI-OS persisted after risk adjustment. For example, after inverse probability weighting, the relative risk for inpatient mortality in the AMI-OS group was 0.67 (95% confidence interval: 0.52-0.86). Inclusion of use of recommended therapies in risk adjustment eliminated the benefit of the AMI-OS, highlighting its mediating effect on adherence to evidence-based treatment.


CONCLUSIONS
Use of an electronic order set is associated with increased adherence to evidence-based care and better AMI outcomes.
Kaiser Permanente Information Technology, Pleasanton, California.
Manuel A
MA
Ballesca
Juan Carlos
JC
LaGuardia
Philip C
PC
Lee
Andrew M
AM
Hwang
David K
DK
Park
Marla N
MN
Gardner
Benjamin J
BJ
Turk
Patricia
P
Kipnis
Gabriel J
GJ
Escobar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000592:standards*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome