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Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

View Article: PubMed Central - PubMed

ABSTRACT

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.

No MeSH data available.


Month‐by‐month statin administration according to study period. For both panels, the first 26 months represent the “before” period with an opt‐in ordering mode for statin prescription, and the second 25 months represent the “after” period with an opt‐out ordering mode for statin prescription. Arrowhead and solid black vertical line indicate timing of transition from opt‐in to opt‐out ordering mode. Solid black horizontal line represents the mean, and dotted black horizontal lines represent the bounds for ±2 SD of the mean. A, Percentage of patients in each month (vertical gray bars) administered a statin at any time during hospitalization. B, Percentage of patients in each month (vertical gray bars) administered a statin within 8 hours of ER triage time.
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jah31614-fig-0001: Month‐by‐month statin administration according to study period. For both panels, the first 26 months represent the “before” period with an opt‐in ordering mode for statin prescription, and the second 25 months represent the “after” period with an opt‐out ordering mode for statin prescription. Arrowhead and solid black vertical line indicate timing of transition from opt‐in to opt‐out ordering mode. Solid black horizontal line represents the mean, and dotted black horizontal lines represent the bounds for ±2 SD of the mean. A, Percentage of patients in each month (vertical gray bars) administered a statin at any time during hospitalization. B, Percentage of patients in each month (vertical gray bars) administered a statin within 8 hours of ER triage time.

Mentions: The rate of inpatient statin administration at any time during ischemic stroke hospitalization was already high in the opt‐in period (87.2%), but it increased a small amount in the opt‐out period (90.7%) (P<0.001). Month‐by‐month statin administration rates are presented in Figure 1A.


Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention
Month‐by‐month statin administration according to study period. For both panels, the first 26 months represent the “before” period with an opt‐in ordering mode for statin prescription, and the second 25 months represent the “after” period with an opt‐out ordering mode for statin prescription. Arrowhead and solid black vertical line indicate timing of transition from opt‐in to opt‐out ordering mode. Solid black horizontal line represents the mean, and dotted black horizontal lines represent the bounds for ±2 SD of the mean. A, Percentage of patients in each month (vertical gray bars) administered a statin at any time during hospitalization. B, Percentage of patients in each month (vertical gray bars) administered a statin within 8 hours of ER triage time.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015276&req=5

jah31614-fig-0001: Month‐by‐month statin administration according to study period. For both panels, the first 26 months represent the “before” period with an opt‐in ordering mode for statin prescription, and the second 25 months represent the “after” period with an opt‐out ordering mode for statin prescription. Arrowhead and solid black vertical line indicate timing of transition from opt‐in to opt‐out ordering mode. Solid black horizontal line represents the mean, and dotted black horizontal lines represent the bounds for ±2 SD of the mean. A, Percentage of patients in each month (vertical gray bars) administered a statin at any time during hospitalization. B, Percentage of patients in each month (vertical gray bars) administered a statin within 8 hours of ER triage time.
Mentions: The rate of inpatient statin administration at any time during ischemic stroke hospitalization was already high in the opt‐in period (87.2%), but it increased a small amount in the opt‐out period (90.7%) (P<0.001). Month‐by‐month statin administration rates are presented in Figure 1A.

View Article: PubMed Central - PubMed

ABSTRACT

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 &ldquo;opt&#8208;in&rdquo; to &ldquo;opt&#8208;out&rdquo; mode of statin ordering. Outcomes were mortality by 90&nbsp;days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time&#8208;series modeling. The EMR intervention increased both overall in&#8208;hospital statin administration (from 87.2% to 90.7%, P&lt;0.001) and early statin administration (from 16.9% to 26.3%, P&lt;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 &lt;8&nbsp;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&#8208;hospital (Pdiff=&minus;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.

No MeSH data available.