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Submitted on July 20, 2004
Accepted on December 7, 2005
Affiliation of the authors: 1 Department of Biomedical Informatics, Vanderbilt University, Nashville, TN; Section of Surgical Sciences, Vanderbilt University, Nashville, TN; 2 Center for Health Services Research, VA Tennessee Valley Healthcare System, Nashville, TN; Department of Medicine, Center for Health Services Research, Vanderbilt University, Nashville, TN; 3 Department of Biomedical Informatics, Vanderbilt University, Nashville, TN ; 4 School of Nursing, Vanderbilt University, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN; 5 Center for Health Services Research, VA Tennessee Valley Healthcare System, Nashville, TN; Department of Medicine, Division of Cardiology Vanderbilt University, Nashville, TN; 6 Department of Biomedical Informatics, Vanderbilt University, Nashville, TN
* To whom correspondence should be addressed.
Objective In the context of an inpatient Care Provider Order Entry (CPOE) system, evaluate the impact of a decision support tool on integration of cardiology best of care order sets into clinicians' admission workflow, and on quality measures for the management of Acute Myocardial Infarction (AMI) patients.
Design A before-and-after study of physician orders evaluated (1) per-patient utilization rates of standardized Acute Coronary Syndrome (ACS) order set and (2) patient-level compliance with two individual recommendations: early aspirin ordering and beta-blocker ordering.
Measurements The effectiveness of the intervention was evaluated for (1) all patients with ACS (suspected for AMI at the time of admission) (n=540) and (2) the subset of the ACS cases who had confirmed discharge diagnoses of AMI (n=180), who comprise the recommended target population who should receive aspirin and/or beta blockers. Compliance rates for use of the ACS order set, aspirin ordering and beta-blocker ordering were calculated as the percentages of patients who had each action performed within 24 hours of admission.
Results For all ACS admissions, the decision support tool significantly increased utilization of the ACS order set (p=0.009). Utilization of the ACS order set led, within the first 24 hours of hospitalization, to a significant increase in the number of patients who received aspirin (p=0.001), and a non-significant increase in the number of patients who received beta-blockers (p=0.07). Results for confirmed AMI cases demonstrated similar increases, but did not reach statistical significance.
Conclusions The decision support tool increased optional utilization of the ACS order set, but room for additional improvement exists.
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