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

OBJECTIVE: To determine the impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care. DESIGN: Observational study. SETTING: Eight acute care hospitals and two specialty heart hospitals. PARTICIPANTS: All adults (>18 years) discharged from one of the included hospitals between December 2007 and March 2009 with a diagnosis of heart failure, who had not undergone heart transplant, did not have a left ventricular assistive device, and with a length of stay of 120 or less days. INTERVENTIONS: A standardized heart failure order set was developed internally, with content driven by the prevailing American College of Cardiology/American Heart Association clinical practice guidelines, and deployed systemwide via an intranet physician portal. MAIN OUTCOME MEASURES: Publicly reported process of care measures, in-patient mortality, 30-day mortality, 30-day readmission, length of stay, and direct cost of care were compared for heart failure patients treated with and without the order set. RESULTS: Order set used reached 73.1% in March 2009. After propensity score adjustment, order set use was associated with significantly increased core measures compliance odds ratio (95% confidence interval) = 1.51(1.08; 2.12) and reduced in-patient mortality odds ratio (95% confidence interval) = 0.49(0.28; 0.88). Reductions in 30-day mortality and readmission approached significance. Direct cost for initial admissions alone and in combination with readmissions were significantly lower with order set use. CONCLUSIONS: Implementing an evidence-based standardized order set may help improve outcomes, reduce costs of care and increase adherence to evidence-based processes of care.