Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the emergency department

Stacy A. Trent, Michael Johnson, Erica A. Morse, Edward P. Havranek, Jason S. Haukoos

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence. Methods: Design: Retrospective study at 3 hospitals in Colorado using standard medical record review. Population: Consecutive adults (≥. 18) hospitalized for acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), or acute ischemic stroke (AIS), who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. Outcome: ED adherence to the CPG (primary); in-hospital mortality and length-of-stay (secondary). Analysis: Multivariable logistic regression using generalized estimating equations was used. Results: Among 1053 patients, ED care was adherent in 84% with significant differences in adherence between CPGs (p <. 0.001) and across institutions (p = 0.04). When patients presented with atypical chief complaints, the odds of receiving adherent care was 0.6 (95% CI 0.4-0.9). When the primary ED diagnosis was associated but not specific to the CPG, the odds of receiving adherent care was 0.5 (95% CI 0.3-0.9) and 0.3 (95% CI 0.2-0.5) for unrelated primary diagnoses. Conclusions: Adherence to ED CPGs for ACS, STEMI and AIS differs significantly between cardiovascular and cerebrovascular diseases and is more likely to occur when the diagnosis is highly suggested by the patient's complaint and acknowledged as the primary diagnosis by the treating ED physician.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2018

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Practice Guidelines
Hospital Emergency Service
Stroke
Acute Coronary Syndrome
Cerebrovascular Disorders
Hospital Departments
Emergency Medical Services
Hospital Mortality
Medical Records
Cause of Death
Length of Stay
Cardiovascular Diseases
Retrospective Studies
Logistic Models
Myocardial Infarction
Physicians
Population

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

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title = "Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the emergency department",
abstract = "Objectives: Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence. Methods: Design: Retrospective study at 3 hospitals in Colorado using standard medical record review. Population: Consecutive adults (≥. 18) hospitalized for acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), or acute ischemic stroke (AIS), who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. Outcome: ED adherence to the CPG (primary); in-hospital mortality and length-of-stay (secondary). Analysis: Multivariable logistic regression using generalized estimating equations was used. Results: Among 1053 patients, ED care was adherent in 84{\%} with significant differences in adherence between CPGs (p <. 0.001) and across institutions (p = 0.04). When patients presented with atypical chief complaints, the odds of receiving adherent care was 0.6 (95{\%} CI 0.4-0.9). When the primary ED diagnosis was associated but not specific to the CPG, the odds of receiving adherent care was 0.5 (95{\%} CI 0.3-0.9) and 0.3 (95{\%} CI 0.2-0.5) for unrelated primary diagnoses. Conclusions: Adherence to ED CPGs for ACS, STEMI and AIS differs significantly between cardiovascular and cerebrovascular diseases and is more likely to occur when the diagnosis is highly suggested by the patient's complaint and acknowledged as the primary diagnosis by the treating ED physician.",
author = "Trent, {Stacy A.} and Michael Johnson and Morse, {Erica A.} and Havranek, {Edward P.} and Haukoos, {Jason S.}",
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doi = "10.1016/j.ajem.2017.12.062",
language = "English (US)",
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T1 - Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the emergency department

AU - Trent, Stacy A.

AU - Johnson, Michael

AU - Morse, Erica A.

AU - Havranek, Edward P.

AU - Haukoos, Jason S.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence. Methods: Design: Retrospective study at 3 hospitals in Colorado using standard medical record review. Population: Consecutive adults (≥. 18) hospitalized for acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), or acute ischemic stroke (AIS), who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. Outcome: ED adherence to the CPG (primary); in-hospital mortality and length-of-stay (secondary). Analysis: Multivariable logistic regression using generalized estimating equations was used. Results: Among 1053 patients, ED care was adherent in 84% with significant differences in adherence between CPGs (p <. 0.001) and across institutions (p = 0.04). When patients presented with atypical chief complaints, the odds of receiving adherent care was 0.6 (95% CI 0.4-0.9). When the primary ED diagnosis was associated but not specific to the CPG, the odds of receiving adherent care was 0.5 (95% CI 0.3-0.9) and 0.3 (95% CI 0.2-0.5) for unrelated primary diagnoses. Conclusions: Adherence to ED CPGs for ACS, STEMI and AIS differs significantly between cardiovascular and cerebrovascular diseases and is more likely to occur when the diagnosis is highly suggested by the patient's complaint and acknowledged as the primary diagnosis by the treating ED physician.

AB - Objectives: Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence. Methods: Design: Retrospective study at 3 hospitals in Colorado using standard medical record review. Population: Consecutive adults (≥. 18) hospitalized for acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), or acute ischemic stroke (AIS), who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. Outcome: ED adherence to the CPG (primary); in-hospital mortality and length-of-stay (secondary). Analysis: Multivariable logistic regression using generalized estimating equations was used. Results: Among 1053 patients, ED care was adherent in 84% with significant differences in adherence between CPGs (p <. 0.001) and across institutions (p = 0.04). When patients presented with atypical chief complaints, the odds of receiving adherent care was 0.6 (95% CI 0.4-0.9). When the primary ED diagnosis was associated but not specific to the CPG, the odds of receiving adherent care was 0.5 (95% CI 0.3-0.9) and 0.3 (95% CI 0.2-0.5) for unrelated primary diagnoses. Conclusions: Adherence to ED CPGs for ACS, STEMI and AIS differs significantly between cardiovascular and cerebrovascular diseases and is more likely to occur when the diagnosis is highly suggested by the patient's complaint and acknowledged as the primary diagnosis by the treating ED physician.

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