Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care

Ballard, David J.; Ogola, Gerald; Fleming, Neil; Stauffer, Brett D.; Leonard, Bradley; Khetan, Rainer; Yancy, Clyde W.

doi:10.1093/intqhc/mzq051

Cited by 55 publications

(37 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Standardization using computerized prescriber order entry (CPOE) technology has influenced prescribing, resulting in reduced costs and improved outcomes (12). To our knowledge, ours is the only study that evaluates the use of CPOE to optimize SUP prescribing.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Multifaceted Intervention on Prescribing of Proton Pump Inhibitors for Stress Ulcer Prophylaxis in the Critically Ill

et al. 2015

View full text Add to dashboard Cite

Background: Lack of well-supported evidence clearly defining one agent as superior to the other for use in stress ulcer prophylaxis (SUP) has led to an array of treatment strategies. Studies comparing histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) have shown H2RAs to be non-inferior to PPIs at preventing clinically significant gastric bleeding. This, in addition to the decreased cost associated with H2RAs, has led to the adoption of H2RAs as the preferred agent for SUP at our institution. Objectives: To evaluate the impact of developing a guideline and removing PPIs from computerized order entry PowerPlans on PPI prescribing for SUP in critically ill patients. Patients and Methods: Members of the critical care service developed a guideline to direct SUP and removed pantoprazole from two critical care admission PowerPlans. In this interventional study with a historical control, adult patients admitted to the medical or surgicaltrauma ICU and prescribed a PPI were evaluated during two time periods before and after the interventions. Patients were excluded if they were receiving a PPI for a reason other than SUP. Patients were assessed daily for an indication for SUP. These included mechanical ventilation, high dose steroids, and coagulopathy. Results: A total of 92 and 60 patients were included in the pre-and post-intervention groups, respectively. PPI use for SUP was reduced from 38% in the pre-intervention group to 15.6% in the post-intervention group (P < 0.0001). PPI days adjusted for LOS were not different between the pre-and post-intervention groups (84% vs 86%, P = 0.5909). Of the total PPI days, 52.4% (95% CI 48.8 -56.1) were classified as inappropriate because there was no indication, while the remaining 47.6% (95% CI 43.9 -51.2) had an indication but should have received a H2RA. The total cost associated with guideline non-adherence was $1802. Conclusions: Our multifaceted intervention reduced the number of days in which a PPI was prescribed for SUP in the overall ICU population; however, it did not impact the duration of PPI therapy. Patients either had no indication for SUP, or had an indication where less costly H2RAs could have been used. Additional opportunity exists to improve cost-effective prescribing of SUP for critically ill patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of a Multifaceted Intervention on Prescribing of Proton Pump Inhibitors for Stress Ulcer Prophylaxis in the Critically Ill

et al. 2015

View full text Add to dashboard Cite

show abstract

“…In addition, studies found that an electronic predictive model had the potential to identify heart failure patients at risk for readmissions or death and demonstrated the use of a heart failure order-set that helps in reducing readmissions. [13,14] In 2011, we found a few publications on hospital to home (H2H) quality improvement initiatives and surgical quality improvement programs. [15] The Veteran Affairs surgical quality improvement program assisted in decreasing surgical complications and readmission rates.…”

Section: Evolution Of Readmission Reduction Strategiesmentioning

confidence: 99%

An environmental analysis of the evolution of readmission reduction strategies: A study of United States hospitals

Upadhyay

Opoku-Agyeman

Borkowski

2017

JHA

View full text Add to dashboard Cite

Objective: Environmental factors have changed the manner in which issues in the U.S. healthcare industry are addressed. One of these changes is in the area of quality improvement, specifically readmission reduction. The purpose of this paper is two-fold: (1) analyze macro-environmental segments (political, technological, economic, and socio-demographic); and (2) trace the historic evolution of readmission reduction programs to understand how macro-environmental factors have shaped the development of readmission reduction strategies. Methods: Scopus, PubMed, and ABI/Inform electronic databases were searched for articles on readmission reduction programs from 2000 to 2014. In addition, literature on macro-environment was retrieved from these sources for the same time period. Studies were identified using specific search terms and inclusion criteria. A total of 24 articles were selected for review. Data on the following variables were extracted: type of organization studied, type of quality improvement strategy used, type of patients studied, and results of the strategy. In addition, an examination of macro-environmental factors that may have affected the above variables was done. Finally, results were integrated and presented in a chronological order. Results: Findings suggest that macro-environmental factors have influenced the development of readmission reduction strategies over time. This paper informs healthcare managers about being cognizant of environmental trends when devising readmission reduction strategies within hospitals. Conclusions: Insights from this paper urge hospital administrators to forge collaborations with key stakeholders while developing new quality improvement strategies when facing an unstable and complex environment.

show abstract

“…Although the effectiveness is dependent on the physician's commitment to using them, admission order sets have been shown to reduce variability and costs, and increase quality of care. 38 Tracking laboratory tests or therapeutics As many patients with HF are volume overloaded, tracking patients who had BNP/NT-proBNP values drawn or who were administered intravenous diuretics offers additional ways to identify patients hospitalized with HF. In limited studies, intravenous diuretic use has been shown to be both sensitive and specific in predicting a discharge diagnosis of HF.…”

Section: Team-based Care Throughout the Hospital Course The Emergencymentioning

confidence: 99%

Team-based Care for Patients Hospitalized with Heart Failure

Larsen

Teerlink

2015

Heart Failure Clinics

View full text Add to dashboard Cite

Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care

Abstract: Implementing an evidence-based standardized order set may help improve outcomes, reduce costs of care and increase adherence to evidence-based processes of care.

Cited by 55 publications

References 36 publications

Impact of a Multifaceted Intervention on Prescribing of Proton Pump Inhibitors for Stress Ulcer Prophylaxis in the Critically Ill

Impact of a Multifaceted Intervention on Prescribing of Proton Pump Inhibitors for Stress Ulcer Prophylaxis in the Critically Ill

An environmental analysis of the evolution of readmission reduction strategies: A study of United States hospitals

Team-based Care for Patients Hospitalized with Heart Failure

Contact Info

Product

Resources

About