The Impact of Standardized Order Sets on Quality and Financial Outcomes

Objective: The objective of this project was to valuate impact of a standardized order set on quality and financial performance. Methods: We conducted an observational study to examine order set use by hospital, discharge month, severity of illness and risk of mortality for pneumonia patients between March 2006 and September 2007. We also assessed impact on in-hospital mortality and 30-day readmission rates using four measures: (1) Cox proportional hazards regression, (2) Joint Commission Core Measures compliance using logistic regression, (3) length of stay, and (4) financial indicators using robust regression methods for highly skewed data. Results: A total of 3,301 patients met the inclusion criteria. Over 19 months, order set use increased by 55 percent. Order set use significantly improved in-hospital mortality [hazard ratio (95 percent confidence interval (CI): 0.66 (0.45; 0.97) or 0.67 (0.46; 0.98); and Core Measures compliance (relative risk, 95 percent CI: 1.24 (1.04; 1.48) or 1.22 (1.02; 1.45)] following covariate or propensity score risk adjustment. Conclusion: Evidence-based pneumonia order sets can reduce inpatient mortality and increase delivery of important care processes.