title: Effectiveness of Evidence-based Pneumonia CPOE Order Sets Measured by Health Outcomes.
abstract: OBJECTIVE
  Evidence-based sets of medical orders for the treatment of patients with common conditions have the potential to induce greater efficiency and convenience across the system, along with more consistent health outcomes. Despite ongoing utilization of order sets, quantitative evidence of their effectiveness is lacking. In this study, conducted at Advocate Health Care in Illinois, we quantitatively analyzed the benefits of community acquired pneumonia order sets as measured by mortality, readmission, and length of stay (LOS) outcomes.
  
  
  METHODS
  In this study, we examined five years (2007-2011) of computerized physician order entry (CPOE) data from two city and two suburban community care hospitals. Mortality and readmissions benefits were analyzed by comparing "order set" and "no order set" groups of adult patients using logistic regression, Pearson's chi-squared, and Fisher's exact methods. LOS was calculated by applying one-way ANOVA and the Mann-Whitney U test, supplemented by analysis of comorbidity via the Charlson Comorbidity Index.
  
  
  RESULTS
  The results indicate that patient treatment orders placed via electronic sets were effective in reducing mortality [OR=1.787; 95% CF 1.170-2.730; P=.061], readmissions [OR=1.362; 95% CF 1.015-1.827; P=.039], and LOS [F (1,5087)=6.885, P=.009, 4.79 days (no order set group) vs. 4.32 days (order set group)].
  
  
  CONCLUSIONS
  Evidence-based ordering practices have the potential to improve pneumonia outcomes through reduction of mortality, hospital readmissions, and cost of care. However, the practice must be part of a larger strategic effort to reduce variability in patient care processes. Further experimental and/or observational studies are required to reduce the barriers to retrospective patient care analyses.
authors.affiliation: Population Health Technology Business Unit, Valence Health Chicago, IL. ; Information Systems Department, Advocate Health Care, Oak Brook, IL. ; Department of Biomedical and Health Information Sciences, University of Illinois, Chicago, IL. ; Department of Biomedical Informatics, Nova Southeastern University, Fort Lauderdale, FL.
authors.forename: Jacob
authors.initials: J
authors.lastname: Krive
authors.affiliation: Department of Family Medicine, Advocate Medical Group, Glenview, IL.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Shoolin
authors.affiliation: Administration, Nevada System of Higher Education, Las Vegas, NV.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Zink
keywords: computerized physician order entry (CPOE); evidence-based medicine; health outcomes research; medication order sets; pneumonia