Improved compliance with quality measures at hospital discharge with a computerized physician order entry system

• HIT Description: Computerized Provider Order Entry More info...
  
• Purpose of Study: To assess the effect of CPOE discharge tools on quality measures for acute myocardial infarction (AMI) and congestive heart failure (CHF)
  
• Years of study: 2001-2003
  
• Study Design: Pre-post
  
• Outcomes: Impact on health care effectiveness and quality
  

• Settings: Vanderbilt University Medical Center, Nashville, TN
• Intervention: CPOE for discharging patients with AMI or CHF
• Evaluation Method: Compared outcomes (prescription of beta-blockers, aspirin use, ejection fraction determination, discharge instructions, counseling) from pre-CPOE period with those after CPOE implementation
• Description: CPOE included point-of-care reminders for the specific quality measures and a prescription writer function. After the discharge tool was completed, letters customized for the patient were printed.
• Interoperability: Operates with existing electronic medical records system
• Strategy: CPOE system development was an iterative process. Changes could occur weekly based on feedback from a complaint button, compliance requirements, etc.
• Barriers: There was confusion between providers and coders on criteria used to assign primary discharge diagnoses. Also, there was no regular feedback on quarterly results; such feedback could have led to increased adoption of the system.
• Cost of Implementation: Implementation cost $37,391; this reflects only incremental costs of implementing the tool on an already extensive established network and hospital computer infrastructure including a biomedical informatics department.
• Quality of Care and Patient Safety Outcome: Smoking cessation counseling increased from 1% to 43% of smokers with CHF and from 21% to 62% of smokers with AMI. Discharge instructions increased from 3% to 56% of CHF patients. The proportion of patients who received discharge prescriptions did not change.