Evaluate the impact of a computerized order set on the adherence to core measures in patients with Community Acquired Pneumonia (CAP).
Study was conducted as a retrospective chart review at a tertiary care academic medical center with mandatory computerized physician order entry (CPOE). Study population was defined as all adult patients admitted between December 2003 and October 2004 whose physicians used a standardized CAP order set. Controls were matched on age and gender over the same time period from patients without use of a CAP order set but within DRG 89 or 90. The groups were compared on five core measures: oxygenation assessment, pneumoccocal vaccination, smoking cessation counseling, and time to blood culture and antibiotics. Length of stay, appropriateness of antibiotic, and admitting services were also compared.
The records of 20 order set and 20 controls were abstracted. Combining all CAP indicators, use of the order set was associated with a significantly greater proportion of quality indicators than controls (60% vs. 40%, p=0.0017). Use of order sets was associated with greater proportion of every quality indicator, although differences were not significant for individual indicators. Proportion of patients receiving appropriate antibiotics (85% vs.75%) and length of stay were not significantly different between the two groups.
Patients whose physicians used the CAP order set were more likely to receive appropriate care.
Use of order sets combined with CPOE may help improve standardization of care and compliance with guidelines established by regulatory agencies. Due to the small size of the study population, the insignificant differences in individual core measures may not accurately predict larger populations. These findings should encourage the support of order set utilization within existing CPOE systems.
Allyson Mirabella, None.