Key result
An EMR modification to an opt-out statin order set increased early statin administration and was associated with an increased rate of survival (difference in probability 0.02, P=0.016).
Why the study?
Does an "opt-out" EMR order set for early statin administration improve survival and clinical outcomes in patients hospitalized with ischemic stroke?
Observational
Yes
Does an "opt-out" EMR order set for early statin administration improve survival and clinical outcomes in patients hospitalized with ischemic stroke?
Effect estimate: Difference in probability 0.02
p-value: p=0.016
Implementing an "opt-out" EMR order set for early statin administration in ischemic stroke significantly increased early statin use and was associated with improved survival and neurological outcomes.
EMR opt-out may boost early statin use and stroke outcomes; observational data leaves open need for RCTs before practice change.
BACKGROUND: Statin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization. METHODS AND RESULTS: This is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an "opt-in" to "opt-out" mode of statin ordering. Outcomes were mortality by 90 days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time-series modeling. The EMR intervention increased both overall in-hospital statin administration (from 87.2% to 90.7%, P<0.001) and early statin administration (from 16.9% to 26.3%, P<0.001). ARIMA models showed a small increase in the rate of survival (difference in probability [Pdiff]=0.02, P=0.016) and discharge to home or rehabilitation facility (Pdiff=0.04, P=0.034) associated with the intervention. The increase in statin administration <8 hours was associated with much larger increases in survival (Pdiff=0.17, P=0.033) and rate of discharge to home or rehabilitation (Pdiff=0.29, P=0.011), as well as a decreased rate of neurological deterioration in-hospital (Pdiff=-0.14, P=0.026). CONCLUSIONS: A simple EMR change increased early statin administration in ischemic stroke and was associated with improved clinical outcomes. This is, to our knowledge, the first EMR intervention study to show that a modification of an electronic order set resulted in improved clinical outcomes.
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Flint et al. (2016) conducted an observational in Ischemic stroke. EMR order set modification to opt-out statin ordering vs. Opt-in statin ordering was evaluated on Survival (Difference in probability 0.02, p=0.016). An EMR modification to an opt-out statin order set increased early statin administration and was associated with an increased rate of survival (difference in probability 0.02, P=0.016).
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