Hospitals that used an electronic discharge orders tool saw their 30-day heart failure (HF) readmission rates fall on average more than 2 percentage points lower than hospitals that did not apply the system. The tool also improved adherence to heart failure quality measures. The results are scheduled to be presented March 10 at the American College of Cardiology (ACC) scientific sessions in San Francisco.
Jose G. Benuzillo, MA, MS, an analyst at Intermountain Healthcare in Salt Lake City, and colleagues designed a retrospective study that evaluated heart failure discharges at Intermountain between January 2011 and September 2012. Their goal was to assess whether the use of electronic discharge orders affect adherence to core measures and 30-day all-cause readmissions of patients with HF.
Initiatives that reduce preventable 30-day HF readmissions have gained interest after October 2012, when the Centers for Medicare & Medicaid Services began penalizing hospitals with higher-than-expected readmission rates for HF, acute MI and pneumonia. The electronic discharge orders tool in the study provided evidence-based decision support for physicians and instructions to patients. It included a computerized discharge system designed to address the discharge process and reduce variability in care.
Benuzillo et al evaluated adherence to three of four HF core measures: discharge instructions, left ventricular evaluation and prescription of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The researchers did not include smoking cessation and counseling “as it is a non-accountability measure.” Their primary outcome was 30-day all-cause readmissions.
They found 2,409 index hospitalizations that were eligible to adhere to at least one of the core measures. The electronic discharge orders tool was used in 55 percent of these hospitalizations, and adherence to all three measures was higher when the discharge tool was used. The readmission rate for patients whose discharge involved the electronic tool was 15.5 percent compared with 18 percent when the tool was not used.
After adjusting for length of stay, age, sex and the severity of HF, Benuzillo et al found the likelihood of readmission remained lower in the patient group that received electronic discharge orders. The presentation is part of the ACC.13 poster presentation sessions.