Mark H Eckman1, Gregory Y H Lip2, Ruth E Wise3, Barbara Speer4, Megan Sullivan5, Nita Walker3, Brett Kissela6, Matthew L Flaherty6, Dawn Kleindorfer6, Peter Baker7, Robert Ireton7, Dave Hoskins7, Brett M Harnett7, Carlos Aguilar8, Anthony C Leonard4, Lora Arduser9, Dylan Steen10, Alexandru Costea10, John Kues4. 1. Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati (UC), Cincinnati, OH; Center for Health Informatics, UC, Cincinnati, OH. Electronic address: mark.eckman@uc.edu. 2. University of Birmingham Centre for Cardiovascular Sciences, Birmingham, United Kingdom. 3. Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati (UC), Cincinnati, OH. 4. Department of Family and Community Medicine, UC, Cincinnati, OH. 5. UC Health, Cincinnati, OH. 6. Department of Neurology, UC, Cincinnati, OH. 7. Center for Health Informatics, UC, Cincinnati, OH. 8. Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati (UC), Cincinnati, OH; Center for Health Informatics, UC, Cincinnati, OH. 9. Department of English, UC, Cincinnati, OH. 10. Division of Cardiology, UC, Cincinnati, OH.
Abstract
BACKGROUND:Appropriate thromboprophylaxis for patients with atrial fibrillation (AF) remains a national challenge. METHODS: We hypothesized that provision of decision support in the form of an Atrial Fibrillation Decision Support Tool (AFDST) would improve thromboprophylaxis for AF patients. We conducted a cluster randomized trial involving 15 primary care practices and 1,493 adults with nonvalvular AF in an integrated health care system between April 2014 and February 2015. Physicians in the intervention group received patient-level treatment recommendations made by the AFDST. Our primary outcome was the proportion of patients with antithrombotic therapy that was discordant from AFDST recommendation. RESULTS: Treatment was discordant in 42% of 801 patients in the intervention group. Physicians reviewed reports for 240 patients. Among these patients, thromboprophylaxis was discordant in 63%, decreasing to 59% 1 year later (P = .02). In nonstratified analyses, changes in discordant care were not significantly different between the intervention group and control groups. In multivariate regression models, assignment to the intervention group resulted in a nonsignificant trend toward decreased discordance (P = .29), and being a patient of a resident physician (P = .02) and a higher HAS-BLED score predicted decreased discordance (P = .03), whereas female gender (P = .01) and a higher CHADSVASc score (P = .10) predicted increased discordance. CONCLUSIONS: Among patients whose physicians reviewed recommendations of the decision support tool discordant therapy decreased significantly over 1 year. However, in nonstratified analyses, the intervention did not result in significant improvements in discordant antithrombotic therapy.
RCT Entities:
BACKGROUND: Appropriate thromboprophylaxis for patients with atrial fibrillation (AF) remains a national challenge. METHODS: We hypothesized that provision of decision support in the form of an Atrial Fibrillation Decision Support Tool (AFDST) would improve thromboprophylaxis for AFpatients. We conducted a cluster randomized trial involving 15 primary care practices and 1,493 adults with nonvalvular AF in an integrated health care system between April 2014 and February 2015. Physicians in the intervention group received patient-level treatment recommendations made by the AFDST. Our primary outcome was the proportion of patients with antithrombotic therapy that was discordant from AFDST recommendation. RESULTS: Treatment was discordant in 42% of 801 patients in the intervention group. Physicians reviewed reports for 240 patients. Among these patients, thromboprophylaxis was discordant in 63%, decreasing to 59% 1 year later (P = .02). In nonstratified analyses, changes in discordant care were not significantly different between the intervention group and control groups. In multivariate regression models, assignment to the intervention group resulted in a nonsignificant trend toward decreased discordance (P = .29), and being a patient of a resident physician (P = .02) and a higher HAS-BLED score predicted decreased discordance (P = .03), whereas female gender (P = .01) and a higher CHADSVASc score (P = .10) predicted increased discordance. CONCLUSIONS: Among patients whose physicians reviewed recommendations of the decision support tool discordant therapy decreased significantly over 1 year. However, in nonstratified analyses, the intervention did not result in significant improvements in discordant antithrombotic therapy.
Authors: Robert J Stanton; Mark H Eckman; Daniel Woo; Charles J Moomaw; Mary Haverbusch; Matthew L Flaherty; Dawn O Kleindorfer Journal: Stroke Date: 2020-01-31 Impact factor: 7.914
Authors: Mark H Eckman; Alexandru Costea; Mehran Attari; Jitender Munjal; Ruth E Wise; Carol Knochelmann; Matthew L Flaherty; Pete Baker; Robert Ireton; Brett M Harnett; Anthony C Leonard; Dylan Steen; Adam Rose; John Kues Journal: Am Heart J Date: 2017-08-23 Impact factor: 4.749
Authors: David R Vinson; E Margaret Warton; Dustin G Mark; Dustin W Ballard; Mary E Reed; Uli K Chettipally; Nimmie Singh; Sean Z Bouvet; Bory Kea; Patricia C Ramos; David S Glaser; Alan S Go Journal: West J Emerg Med Date: 2018-02-12
Authors: Jeffrey M Ashburner; Steven J Atlas; Shaan Khurshid; Lu-Chen Weng; Olivia L Hulme; Yuchiao Chang; Daniel E Singer; Patrick T Ellinor; Steven A Lubitz Journal: J Gen Intern Med Date: 2018-08-03 Impact factor: 6.473