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Improvements in 1-Year Cardiovascular Clinical Outcomes Associated with a Hospital-Based Discharge Medication Program

Jason M. Lappé, MS; Joseph B. Muhlestein, MD; Donald L. Lappé, MD; Rodney S. Badger, MD; Tami L. Bair, BS; Ruth Brockman, RN, MBA; Thomas K. French, MStat; Linda C. Hofmann, MS, BSN; Benjamin D. Horne, MStat, MPH; Susan Kralick-Goldberg, RN, MSN; Nan Nicponski, RN, MBA; Janette A. Orton, RN, MS; Robert R. Pearson, BS; Dale G. Renlund, MD; Holly Rimmasch, RN, MSN; Colleen Roberts, RN, MS; and Jeffrey L. Anderson, MD
[+] Article, Author, and Disclosure Information

From Intermountain Health Care, LDS Hospital, Salt Lake City, Utah.

Acknowledgments: The authors thank Julie Burchell, RN, BSN; Michael Carnley; Dal C. Coleman, RPh; Kim Henrichsen, RN, MS, CCRN; Diane Marshall, MAM; Mikelle D. Moore, MBA, MHSA; Lynn R. Nimer, MD; Katey Roundy; Shane R. Stevenson, BS; Diane S. Wallace, RN, MSN, ANP-C; Sharon L. Watson, RHIT; Marie M. Wright, RN; Scott Yardley, RPh; Michelle LeBaron, RN; Susan E. Pollock, BS; Jeanette Wheeler, RN; and the administrative, cardiovascular nursing, and physician staff of Intermountain Health Care for valuable contributions and assistance.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Joseph B. Muhlestein, MD, LDS Hospital Cardiovascular Department, 8th Avenue and C Street, Salt Lake City, UT 84143.

Current Author Addresses: Mr. Lappé; Drs. Muhlestein, Lappé, Badger, Renlund, and Anderson; Ms. Bair; Ms. Brockman; Mr. French; Ms. Hofmann; Mr. Horne; Ms. Kralick-Goldberg; Ms. Nicponski; Ms. Orton; Mr. Pearson; Ms. Rimmasch; and Ms. Roberts: LDS Hospital Cardiovascular Department, 8th Avenue and C Street, Salt Lake City, UT 84143.

Ann Intern Med. 2004;141(6):446-453. doi:10.7326/0003-4819-141-6-200409210-00010
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Intermountain Health Care (IHC) is a nonprofit, integrated health care system including 20 hospitals, a system of health plans, and both employed and affiliated physicians. The approximately 400 employed physicians mainly practice primary care, and the approximately 2500 affiliated physicians are mostly specialists. Intermountain Health Care serves approximately 60% of the population of Utah and southern Idaho. The system's 10 largest hospitals were included in the quality improvement initiative, accounting for more than 90% of the total population of cardiovascular patients.

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Figure 1.
Proportions of patients receiving the appropriate discharge prescriptions.

The 5 targeted medications were given as indicated to patients without documented contraindications before and more than 3 years after implementation of the discharge medication program (1998 and 2002, respectively). Data for 1998 and 2002 were collected through the same process. ACE = angiotensin-converting enzyme.

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Figure 2.
Adjusted relative risks for death and readmission at 30-day and 1-year follow-up for patients before and after implementation of the discharge medication program.

Top. All patients in the study sample. Middle. Subgroups defined by diagnostic or procedural criteria (not by indication for treatment with a specific medication) for death. Bottom. Subgroups defined by diagnostic or procedural criteria (not by indication for treatment with a specific medication) for readmission. CABG = coronary artery bypass grafting; CHD = coronary heart disease; HF = heart failure; MI = myocardial infarction.

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Figure 3.
Relative risk for readmission or death among patients with atrial fibrillation.
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Appendix Figure 1.
Physician and clinical staff reference card for the Intermountain Health CareIHC) discharge medication program.

( ACE = angiotensin-converting enzyme; ARB = angiotensin-receptor blocker; ASA = aspirin; CAD = coronary artery disease; EF = ejection fraction; HMG = hydroxy-3-methylglutaryl; LDL = low-density lipoprotein; LV = left ventricular; MI = myocardial infarction.

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Summary for Patients

Improvements in 1-Year Outcomes before and after a Discharge Medication Program for Patients Hospitalized with Heart Disease

The summary below is from the full report titled “Improvements in 1-Year Cardiovascular Clinical Outcomes Associated with a Hospital-Based Discharge Medication Program.” It is in the 21 September 2004 issue of Annals of Internal Medicine (volume 141, pages 446-453). The authors are J.M. Lappé, J.B. Muhlestein, D.L. Lappé, R.S. Badger, T.L. Bair, R. Brockman, T.K. French, L.C. Hofmann, B.D. Horne, S. Kralick-Goldberg, N. Nicponski, J.A. Orton, R.R. Pearson, D.G. Renlund, H. Rimmasch, C. Roberts, and J.L. Anderson.


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