Use of Discharge-Worksheet Enhances Compliance with Evidence-Based Myocardial Infarction Care
- 62 Downloads
Background: Prior studies demonstrate that effective secondary prevention therapies are underutilized in patients with myocardial infarction (MI) at hospital discharge. At a US tertiary center, we developed and encouraged providers to complete a simple “Acute MI Discharge Worksheet” (MIDW) designed to educate patients, prompt caregivers, and provide chart documentation regarding evidence-based therapies post-MI.
Methods and Results: The MIDW was introduced in May of 2000 with use encouraged in all surviving patients with MI. We calculated a patient discharge score by summing the number of quality indicators (aspirin use, beta-blocker use, ACE-inhibitor use, smoking cessation, lipid-lowering therapy, cardiac rehabilitation referral) and compared documentation of quality indicators at discharge between patients without (Group I, n = 65) and with (Group II, n = 60) the MIDW. Group II was subdivided into those with an incomplete worksheet (Group IIa, n = 26), and those with a completed worksheet (Group IIb, n = 34). Greater documentation of secondary prevention indicators occurred in patients with incomplete and completed discharge forms present. Mean Discharge scores were significantly higher for Group II vs. Group I (4.98 vs. 3.88, p < 0.0001), and Group IIb vs. Group IIa, (5.47 vs. 4.35, p < 0.001).
Conclusion: A simple “Acute MI Discharge Worksheet” was associated with better adherence and documentation of evidence-based post MI care and be a useful component to improve post MI care.
Unable to display preview. Download preview PDF.
- 1.Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease. The Lancet1994;344: 1383–1389.Google Scholar
- 2.ISIS-2 Collaborative Group. Second International Study of Infarct Survival. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. The Lancet1988;2: 349–359.Google Scholar
- 3.Hennikens C, Albert C, Godfried S, Gaziano M, Burning J. Adjunctive drug therapy of acute myocardial infarction— evidence from clinical trials. The New England Journal of Medicine1996;335: 1660–1667.Google Scholar
- 4.Oldridge NB. Cardiac rehabilation after myocardial infarction. JAMA1988;260: 945–950.Google Scholar
- 5.Jencks S, Cuerdon T, Burwen D, Fleming B, Housck P. Quality of medical care delivered to medicare beneficiaries. Journal of the American Medical Association2000;284: 1670–1676.Google Scholar
- 6.Ryan TJ, Anderson JL, Antman EM. ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines. Journal of the American College of Cardiology1996;28: 1328–1342.Google Scholar
- 7.Ellerbeck E, Jencks S, Radford M, Kresowik T, Craig A, Gold J. Quality of care for medicare patients with acute myocardial infarction. JAMA1995;273: 1509–1514.Google Scholar
- 8.Singh P, Lopez-Candales A. Suboptimal use of adjunctive pharmacologic strategies in survivors of an acute myocardial infarction: a survey from the Western New York Region. J Invest Med1998;46: 290.Google Scholar
- 9.Mehta R, Das S, Tsai T. Quality improvement initiative and its impact on the management of patients with acute myocardial infarction. Arch Intern Med2000;160: 3057–3062.Google Scholar
- 10.Euroaspire Group I and II. Clinical reality of coronary prevention guidelines: a comparison of Euroaspire I and II in nine countries. The Lancet2001;357: 995–1001.Google Scholar
- 11.Marciniak T, Ellerbeck E, Radford M, et al. Improving the quality of care for medicare patients with acute myocardial infarction. JAMA1998;279: 1351–1357.Google Scholar
- 12.Axtell S, Ludwig E, Lopez-Candales A. Intervention to improve adherence to ACC/AHA recommentded adjunctive medications for the management of patients with acute myocardical infarction. Clin Cardiol2001;24: 114–118.Google Scholar
- 13.Lee T, Pearson S, Johnson PA, et al. Failure of information as an intervention to modify clinical management. A time-series trial in patients with acute chest pain. Ann Intern Med1994;122: 434–437.Google Scholar
- 14.Mehta R, Eagle K, Riba A, Winston S, Sobotka P, Montoye C. Improving quality of care for acute myocardial infarction. The Guidelines Applied in Practice (GAP) Initiative. JAMA2002;287: 1269–1276.Google Scholar