Document Type

Article

Publication Date

9-16-2026

Comments

This article is the author’s final published version in JACC: Case Reports, Volume 31, Issue 37, 2026, Article number 109888.

The published version is available at https://doi.org/10.1016/j.jaccas.2026.109888. Copyright © 2026 THE AUTHORS.

 

Abstract

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.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

42752008

Language

English

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