Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care
| Autor: | David J. Ballard, Bradley M. Leonard, Brett D. Stauffer, Rainer A. Khetan, Neil S. Fleming, Clyde W. Yancy, Gerald Ogola |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Specialty Psychological intervention Observation Patient Readmission Young Adult Acute care Outcome Assessment Health Care medicine Humans Intensive care medicine Aged Aged 80 and over Heart Failure business.industry Health Policy Public Health Environmental and Occupational Health Standard of Care General Medicine Odds ratio Length of Stay Middle Aged medicine.disease Texas United States Confidence interval Evidence-Based Practice Heart failure Propensity score matching Costs and Cost Analysis Female Observational study Guideline Adherence business |
| Zdroj: | International Journal for Quality in Health Care. 22:437-444 |
| ISSN: | 1464-3677 1353-4505 |
| DOI: | 10.1093/intqhc/mzq051 |
| Popis: | Objective To determine the impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care. Design Observational study. Setting Eight acute care hospitals and two specialty heart hospitals. Participants All adults (>18 years) discharged from one of the included hospitals between December 2007 and March 2009 with a diagnosis of heart failure, who had not undergone heart transplant, did not have a left ventricular assistive device, and with a length of stay of 120 or less days. Interventions A standardized heart failure order set was developed internally, with content driven by the prevailing American College of Cardiology/American Heart Association clinical practice guidelines, and deployed systemwide via an intranet physician portal. Main Outcome Measures Publicly reported process of care measures, in-patient mortality, 30-day mortality, 30-day readmission, length of stay, and direct cost of care were compared for heart failure patients treated with and without the order set. Results Order set used reached 73.1% in March 2009. After propensity score adjustment, order set use was associated with significantly increased core measures compliance [odds ratio (95% confidence interval) = 1.51(1.08; 2.12)] and reduced in-patient mortality [odds ratio (95% confidence interval) = 0.49(0.28; 0.88)]. Reductions in 30-day mortality and readmission approached significance. Direct cost for initial admissions alone and in combination with readmissions were significantly lower with order set use. Conclusions Implementing an evidence-based standardized order set may help improve outcomes, reduce costs of care and increase adherence to evidence-based processes of care. |
| Databáze: | OpenAIRE |
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