ACEi/ARB for systolic heart failure: closing the quality gap with a sustainable intervention at an academic medical center

Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine
Qi QianFrancisco Lopez-Jimenez

Abstract

National guidelines recommend angiotensin converting enzyme inhibitor (ACEi) or angiotensinogen receptor blocker (ARB) therapy for patients with left ventricular systolic dysfunction (LVSD), including those with symptomatic heart failure (HF). However, guideline adherence has not been optimal. The goal of this quality improvement project is to devise and implement a sustainable care-delivery model in a 920-bed academic hospital center that would improve ACEi/ARB adherence before hospital discharge. The Model of intervention is: (1) a computer-based daily screening program; (2) inpatient pharmacist e-flag message; and (3) alerts for inpatient care teams. Its operating algorithm: If eligible adult HF/LVSD inpatients are not on ACEi or ARB nor documentation of contraindications, a flag alert is generated; deficiency is confirmed by a pharmacist and conveyed to the patient-care teams; if alert is acted on and care brought into adherence, the screening program would not re-flag the same patients the succeeding day; if not, the patients would be re-flagged daily until reaching adherence. We compared ACEi/ARB adherence before, during, and after the intervention. Baseline performance (percentage of eligible HF/LVSD patients receiving A...Continue Reading

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Citations

Dec 19, 2013·BMC Medical Informatics and Decision Making·Christopher L FillmoreKensaku Kawamoto
Nov 20, 2013·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Pedro J CaraballoQi Qian
Apr 18, 2019·JMIR Human Factors·Saul BleckerJonathan S Austrian

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