Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care.
Int J Qual Health Care
; 22(6): 437-44, 2010 Dec.
Article
in En
| MEDLINE
| ID: mdl-20935009
ABSTRACT
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 OUTCOMEMEASURES:
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.
Full text:
1
Collection:
01-internacional
Health context:
1_ASSA2030
/
6_ODS3_enfermedades_notrasmisibles
Database:
MEDLINE
Main subject:
Patient Readmission
/
Outcome Assessment, Health Care
/
Standard of Care
/
Heart Failure
Type of study:
Guideline
/
Health_economic_evaluation
/
Observational_studies
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Int J Qual Health Care
Year:
2010
Document type:
Article