Designing a comprehensive strategy to improve one core measure: discharge of patients with myocardial infarction or heart failure on ACE inhibitors/ARBs

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
Calie SantanaRohit Bhalla

Abstract

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEs/ARBs) have proven benefit for patients with myocardial infarction and heart failure; their use is a core measure of hospital quality for the Centers for Medicare and Medicaid Services. The authors' urban medical center has lower-than-average performance on this measure. The authors used published best practices to design and implement a comprehensive strategy to improve ACE/ARB performance with existing decision support and human resources. Chart reminders were targeted to providers of patients eligible for ACEs/ARBs but not receiving them. ACE/ARB performance increased 8.5% in postintervention patients compared with historical controls. The increase was 20.7% among patients not on ACEs/ARBs on admission (P =.03). Chronic kidney disease (CKD) was inversely associated with the effectiveness of the intervention. A comprehensive strategy can be effective in narrowing the performance gap even for populations with a high prevalence of CKD. However, future work is needed to improve performance among patients whose ACEs/ARBs are withheld during hospitalization.

References

Mar 12, 2002·JAMA : the Journal of the American Medical Association·Rajendra H MehtaUNKNOWN GAP Steering Committee of the American College of Cardiology
Oct 19, 2004·Journal of the American College of Cardiology·Justin EzekowitzUNKNOWN APPROACH Investigators
Dec 17, 2010·World Journal of Cardiology·Farhan AslamJacob Joseph

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Methods Mentioned

BETA
coronary artery bypass

Software Mentioned

SPSS
Clinical Looking Glass ( CLG

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