Increasing compliance with national quality measures for stroke through use of a standard order set.

Abstract

Results of a study to determine the impact of physician use of a medication order set on compliance with national quality standards for acute stroke treatment are presented. The medical records of adult patients treated for ischemic stroke at three certified primary stroke centers within a large healthcare system were retrospectively reviewed to assess compliance with eight mandatory standards of care. Overall adherence to the standards and rates of compliance with individual standards were compared in random samples of patients treated with or without physician use of an order set providing guidance on acute stroke pharmacotherapy and other aspects of stroke management. Treatment records indicated use of the acute stroke order set in 58% of the 120 patient cases reviewed. Individual patients who were treated without physician use of the order set were more than twice as likely as those in the comparator group to receive care that was not in compliance with at least one of the eight mandatory quality standards (odds ratio, 2.4; 95% confidence interval, 1.43-4.05; p < 0.001). Use of the order set was associated with significantly improved adherence to three standards: venous thromboembolism prophylaxis, stroke education, and statin therapy at discharge. A retrospective review of the treatment records of patients hospitalized for acute stroke showed that adherence to national guidelines was increased when providers used a standard order set.