The use of electronic discharge orders aimed at providing evidence-based decision support and clear instructions to heart failure patients helped increase compliance with quality care measures and lowered hospital readmission rates, according to research being presented at the American College of Cardiology's 62nd Annual Scientific Session.
Despite more widespread use of standardized discharge orders and evidence suggesting their effectiveness, little is known about how they impact adherence to quality measures or hospital readmission rates among heart failure patients. This study showed use of a computerized discharge system was associated with a 23 percent lower all-cause hospital readmission rate and a 10-fold increase in compliance with quality care measures.
Researchers conducted a retrospective study of heart failure patients discharged from 11 hospitals across Utah between January 2011 and September 2012 to determine whether the use of an electronic discharge orders tool was associated with higher adherence to core measures-considered medical "best practices" in heart failure care-and lower hospital readmissions. As part of the Affordable Care Act's effort to improve quality while also saving taxpayers dollars, Medicare has recently started fining hospitals that have too many patients readmitted within 30 days of their discharge-a widely accepted marker of sub-optimal care. The electronic discharge tool, first piloted in 2010, was designed to cover all aspects of the discharge process and includes integrated decision-support tools and safeguards to guide clinicians through the recommended steps for heart failure patients.
"The tool was designed by our most skilled cardiovascular practitioners to mirror the workflow of the physician and provide evidence-based decision support for cardiovascular care," said Jose G. Benuzillo, MA, MS, a senior outcomes analyst at Intermountain Healthcare in Salt Lake City and the study's lead investigator. "Use of this tool reduces variation in practice between the most skilled and experienced specialists in cardiovascular care and more general practitioners who see cardiovascular patients more infrequently."
He said it has also improved communication between the patient and clinician by providing a clear, legible document that addresses all best practice orders, instructions and medications.