Becker's Clinical Quality & Infection Control

51 QUALITY IMPROVEMENT & MEASUREMENT 7-part score could help determine heart attack readmissions, study finds By Megan Knowles W hen physicians track seven factors of heart attack patients after they are first admitted to the hospital, they can help identify those with the highest risk for 30-day readmission, researchers from Dallas-based UT Southwestern Medical Center found. The findings of the study, published in the Journal of the American Heart Association, may help recognize patients who could benefit from early interventions that let them recover at home, reducing healthcare costs, the researchers said. "Identifying the most vulnerable patients is the first step to getting these patients the specialized care they need as they are transitioning from hospital to home, so that they are then able to make a full recovery at home instead of having to come back to the hospital," said study author Oanh Nguyen, MD. Most prediction models for heart attack patients have poor to modest success finding those most likely to be re- admitted. Currently, about 1 in 6 heart attack patients, or acute myocardial infarction patients, have an unplanned hospital readmission within 30 days of discharge, the study authors note. "We found that a simple score, the AMI READMITS score, helps physicians accurately predict which patients hospi- talized for heart attacks are at high risk of 30-day read- missions," Dr. Nguyen said. "The AMI READMITS score is based on seven clinical and demographic factors that are readily available on all patients on the first day of their hospitalization." Here are the seven READMITS factors, which can be tracked on a patient's first day of hospitalization: • Renal (kidney) function • Elevated brain natriuretic peptide (heart strain marker) • Age • Diabetes mellitus • NonMale sex • Intervention with timely percutaneous coronary inter- vention (i.e., heart stents) • Low Systolic blood pressure "We hope that the score will help physicians and hospi- tals better tailor and improve the quality of care for pa- tients during and immediately after a hospitalization for a heart attack," Dr. Nguyen said. "Additionally, because the score is simple and easy to calculate, physicians can use it at the bedside to determine a patient's risk of hospital readmission." Although physicians can find high-risk patients early in their stay, it doesn't necessarily mean interventions to reduce readmissions will be successful, Dr. Nguyen said. "That is the ultimate goal and something that we are actively working on." n Risk of complications increases 29% when physicians don't follow EHR alerts, study suggests By Jessica Kim Cohen P roviders who adhere to clinical decision support alerts embedded in EHRs report better clinical outcomes for their patients than those who don't, according to a study published in the American Journal of Managed Care. Researchers from Los Angeles-based Cedars-Sinai Medical Center and consultancy Optum Advisory Services re- viewed data from more than 26,000 inpatient visits during the study, dividing patients into two groups: one in which the provider adhered to all CDS alerts, and one in which the provider did not adhere to the recommendations. The CDS alerts were from Choosing Wisely, a program developed by the American Board of Internal Medicine Foundation. Choosing Wisely alerts providers when care instructions deviate from existing industry guidelines, such as if a provider orders a CT scan that may not be necessary or if a provider prescribes a sedative for a patient at risk for falls. The odds of experiencing a complication increased by 29 percent for patients whose physicians did not follow CDS alerts, and the odds of a hospital readmission increased by 14 percent. These patients also experienced a 6.2 percent increase in their length of stay and a 7.3 percent increase in costs. "Sometimes doctors order tests that they think are in the patient's best interest, when research doesn't show that to be the case," Harry Sax, MD, executive vice chair of surgery at Cedars-Sinai and senior author on the study, said. "This work is about giving the right care that patients truly need." n

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