EHR-Based Quality Interventions Associated With Differential GDMT Prescribing in Community Versus Academic Hospitals.

BACKGROUND

Institutional barriers are associated with suboptimal guideline-directed medical therapy (GDMT) prescribing at heart failure discharge.

PROJECT RATIONALE: Practice variations between academic medical centers (defined as "teaching" hospitals with residents) and community hospitals are poorly understood. Evaluating how diverse settings respond to quality improvement strategies is vital.

PROJECT SUMMARY: A multicenter study across 10 electronic health record-unified hospitals evaluated 3,535 heart failure encounters. Phase 1 implemented educational work groups and financial incentives; phase 2 introduced clinical decision support systems. Community hospitals responded significantly to phase 1 education/incentives, with mean discharge of GDMT agents rising from 2.19 to 2.44 (P = 0.0028). Academic medical centers improved significantly only after the implementation of phase 2 clinical decision support systems, rising from 2.27 to 2.48 GDMT agents (P = 0.0009).

TAKE-HOME MESSAGES: Community settings respond to education and financial incentives, whereas academic settings require hardwired digital workflows. Enterprise quality improvement initiatives must match deployment strategies to institutional context.