Scott C Woller1, Scott M Stevens2, Steven Towner3, Jeff Olson4, Paige Christensen3, Sharon Hamilton5, Laurel Newman5, Loren Mott5, Ping Hu6, Kimberly D Brunisholz5, Yenh Long7, Jim Lloyd8, R Scott Evans8, Wayne Cannon5, C Greg Elliott2. 1. Department of Medicine, Intermountain Medical Center, Murray, UT, USA Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA scott.woller@imail.org. 2. Department of Medicine, Intermountain Medical Center, Murray, UT, USA Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. 3. Intermountain Healthcare Salt Lake Clinic, Salt Lake City, UT, USA. 4. Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA. 5. Intermountain Healthcare, Salt Lake City, UT, USA. 6. Intermountain Healthcare Homer Warner Center for Medical Informatics, Murray, UT, USA. 7. Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA Roseman University of Health Sciences, South Jordan, UT, USA. 8. Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA.
Abstract
BACKGROUND: An explicit approach to warfarin dose adjustment using computerized clinical decision support (CDS) improves warfarin management. We report metrics of quality for warfarin management before and after implementation of CDS in a large health care system. METHODS: A total of 2591 chronically anticoagulated patients were eligible for inclusion. We compared interpatient time in therapeutic range (TTR) and international normalized ratio (INR) variability before and after implementation of CDS. We report outcomes of major bleeding, thrombosis, and health care utilization. RESULTS: Implementation of CDS significantly improved TTR (from 63.99% to 65.13%; P = .04) and reduced out-of-range INRs (from 42.39% to 39.97%; P < .001). Venous thromboembolism (relative risk [RR] 0.41; P < .001) emergency department utilization (RR 0.62; P < .001), and hospitalization (RR 0.62; P < .001) were reduced after CDS implementation. Major hemorrhage was more frequent after CDS implementation (RR 1.42; P = .01). CONCLUSION: The CDS warfarin management was associated with improved TTR and decreased INR variability in a large cohort of chronically anticoagulated patients. Clinically relevant outcomes were broadly improved, although more bleeding events were observed.
BACKGROUND: An explicit approach to warfarin dose adjustment using computerized clinical decision support (CDS) improves warfarin management. We report metrics of quality for warfarin management before and after implementation of CDS in a large health care system. METHODS: A total of 2591 chronically anticoagulated patients were eligible for inclusion. We compared interpatient time in therapeutic range (TTR) and international normalized ratio (INR) variability before and after implementation of CDS. We report outcomes of major bleeding, thrombosis, and health care utilization. RESULTS: Implementation of CDS significantly improved TTR (from 63.99% to 65.13%; P = .04) and reduced out-of-range INRs (from 42.39% to 39.97%; P < .001). Venous thromboembolism (relative risk [RR] 0.41; P < .001) emergency department utilization (RR 0.62; P < .001), and hospitalization (RR 0.62; P < .001) were reduced after CDS implementation. Major hemorrhage was more frequent after CDS implementation (RR 1.42; P = .01). CONCLUSION: The CDS warfarin management was associated with improved TTR and decreased INR variability in a large cohort of chronically anticoagulated patients. Clinically relevant outcomes were broadly improved, although more bleeding events were observed.
Authors: Raj Mehta; Nila S Radhakrishnan; Carrie D Warring; Ankur Jain; Jorge Fuentes; Angela Dolganiuc; Laura S Lourdes; John Busigin; Robert R Leverence Journal: Appl Clin Inform Date: 2016-08-17 Impact factor: 2.342
Authors: T Jared Bunch; Victoria Jacobs; Heidi May; Scott M Stevens; Brian Crandall; Michael Cutler; John D Day; Charles Mallender; Jeff Olson; Jeffrey Osborn; J Peter Weiss; Scott C Woller Journal: Clin Cardiol Date: 2019-04-10 Impact factor: 2.882
Authors: Scott C Woller; Scott M Stevens; R Scott Evans; Daniel Wray; John Christensen; Valerie T Aston; Matthew Wayne; James F Lloyd; Emily L Wilson; C Gregory Elliott Journal: Res Pract Thromb Haemost Date: 2018-06-07