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Triller DM, Wilson AS, Allen AL, Burnett AE, Gouveia-Pisano JA, Brenner A, Pritchard BK, Medico C, Barnes GD. Digital dashboards for direct oral anticoagulant surveillance, intervention and operational efficiency: uptake, obstacles, and opportunities. J Thromb Thrombolysis 2024; 57:107-116. [PMID: 37839023 PMCID: PMC10830621 DOI: 10.1007/s11239-023-02893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/17/2023]
Abstract
Direct oral anticoagulants (DOAC) are the most widely prescribed oral anticoagulants in the United States. Despite advantages over warfarin, system-level improvements are needed to optimize outcomes. While Veterans Health Administration and others have described successful DOAC management dashboard implementation, the extent of use nationally is unknown. A survey of Anticoagulation Forum's members was conducted to assess access to digital tools available within a dashboard and to describe implementation models. An Expert Forum was subsequently convened to identify barriers to dashboard development and adoption. Responses were received from 340 targeted recipients (8.5% of invitees). Only a minority of inpatient (25/52, 48.1%) and outpatient (47/133, 35.3%) respondents outside of Veterans Health Administration were able to generate rosters of DOAC users on-demand, and fewer had the ability to digitally display key clinical data elements, identify drug-related problems, document interventions, or generate reports. The lack of regulatory requirements regarding Anticoagulation Stewardship was identified by the Expert Forum as the major barrier to widespread development of digital tools for improved anticoagulation management. While some health systems have demonstrated the feasibility of DOAC dashboards and described their impact on quality and efficiency, these tools do not appear to be widely available in the United States apart from Veterans Health Administration. The lack of regulatory requirements for Anticoagulation Stewardship may be the primary barrier to the development of digital resources to better manage anticoagulants. Efforts to secure regulatory requirements for Anticoagulation Stewardship are needed, and evidence of improvements in clinical and financial outcomes through DOAC dashboard use will likely bolster such efforts.
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Affiliation(s)
- Darren M Triller
- Anticoagulation Forum, 17 Lincoln St, Suite 2B, Newton, MA, 02461, USA.
| | - Aaron S Wilson
- University of Utah College of Pharmacy, Salt Lake City, UT, 84112, USA
| | - Arthur L Allen
- Veterans Administration Salt Lake City Health Care System, Salt Lake City, UT, USA
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2
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Wilson AS, Triller DM, Allen A, Burnett A, Gouveia-Pisano JA, Brenner A, Pritchard B, Medico C, Vazquez SR, Witt DM, Barnes GD. Digital dashboards for oral anticoagulation management: a literature scoping review. J Thromb Thrombolysis 2023; 56:568-577. [PMID: 37596426 PMCID: PMC10550856 DOI: 10.1007/s11239-023-02880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/20/2023]
Abstract
This scoping review summarizes the extent and characteristics of the published literature describing digital population management dashboards implemented to improve the quality of anticoagulant management. A standardized search protocol was executed to identify relevant manuscripts published between January 1, 2015 and May 31, 2022. The resulting records were systematically evaluated by multiple blinded reviewers and the findings from selected papers were evaluated and summarized. Twelve manuscripts were identified, originating from 5 organizations within the US and 2 from other countries. The majority (75%) described implementation in the outpatient setting. The identified papers described a variety of positive results of dashboard use, including a 24.5% reduction of questionable direct oral anticoagulant dosing in one organization, a 33.3% relative improvement in no-show appointments in an ambulatory care clinic, and a 75% improvement in intervention efficiency. One medical center achieved a 98.4% risk-appropriate venous thromboembolism risk prophylaxis prescribing rate and 40.6% reduction in anticoagulation-related adverse event rates. The manuscripts primarily described retrospective findings from single-center dashboard implementation experiences. Digital dashboards have been successfully implemented to support the anticoagulation of acute and ambulatory patients and available manuscripts suggest a positive impact on care-related processes and relevant patient outcomes. Prospective studies are needed to better characterize the implementation and impact of dashboards for anticoagulation management. Published reports suggest that digital dashboards may improve the quality, safety, and efficiency of anticoagulation management. Additional research is needed to validate these findings and to understand how best to implement these tools.
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Affiliation(s)
- Aaron S Wilson
- University of Utah College of Pharmacy, Salt Lake City, UT, 84112, USA
| | - Darren M Triller
- Anticoagulation Forum, 17 Lincoln St, Suite 2B, Newton, MA, 02461, USA.
| | - Arthur Allen
- VA Salt Lake City Health Care System, Salt Lake City, UT, 84108, USA
| | - Allison Burnett
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87102, USA
| | | | | | | | | | - Sara R Vazquez
- University of Utah College of Pharmacy, Salt Lake City, UT, 84112, USA
| | - Dan M Witt
- University of Utah College of Pharmacy, Salt Lake City, UT, 84112, USA
| | - Geoffrey D Barnes
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, 48109, USA
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3
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Ranusch A, Lin YJ, Dorsch MP, Allen AL, Spoutz P, Seagull FJ, Sussman JB, Barnes GD. Role of Individual Clinician Authority in the Implementation of Informatics Tools for Population-Based Medication Management: Qualitative Semistructured Interview Study. JMIR Hum Factors 2023; 10:e49025. [PMID: 37874636 PMCID: PMC10630856 DOI: 10.2196/49025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Direct oral anticoagulant (DOAC) medications are frequently associated with inappropriate prescribing and adverse events. To improve the safe use of DOACs, health systems are implementing population health tools within their electronic health record (EHR). While EHR informatics tools can help increase awareness of inappropriate prescribing of medications, a lack of empowerment (or insufficient empowerment) of nonphysicians to implement change is a key barrier. OBJECTIVE This study examined how the individual authority of clinical pharmacists and anticoagulation nurses is impacted by and changes the implementation success of an EHR DOAC Dashboard for safe DOAC medication prescribing. METHODS We conducted semistructured interviews with pharmacists and nurses following the implementation of the EHR DOAC Dashboard at 3 clinical sites. Interview transcripts were coded according to the key determinants of implementation success. The intersections between individual clinician authority and other determinants were examined to identify themes. RESULTS A high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard (communication, staffing and work schedule, job satisfaction, and EHR integration). Conversely, a lack of individual authority was often associated with key barriers to effective DOAC Dashboard use. Positive individual authority was sometimes present with a negative example of another determinant, but no evidence was found of individual authority co-occurring with a positive instance of another determinant. CONCLUSIONS Increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard and positively affects other aspects of implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13012-020-01044-5.
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Affiliation(s)
- Allison Ranusch
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Ying-Jen Lin
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Arthur L Allen
- Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Patrick Spoutz
- Veterans Integrated Service Network 20 Northwest Network, Vancouver, WA, United States
| | - F Jacob Seagull
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jeremy B Sussman
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Geoffrey D Barnes
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
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4
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Lin YJ, Ranusch A, Seagull FJ, Sussman JB, Barnes GD. Dynamic interplay between available resources and implementation climate across phases of implementation: a qualitative study of a VA national population health tool. Implement Sci Commun 2023; 4:74. [PMID: 37386501 DOI: 10.1186/s43058-023-00460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Available resources within an organization can determine the implementation success of an intervention. However, few studies have investigated how the required resources change over the phases of implementation. Using stakeholder interviews, we examined the changes in and interactions between available resources and implementation climate in the implementation and sustainment phases of a national implementation effort for a population health tool. METHODS We conducted a secondary analysis of the interviews with 20 anticoagulation professionals at 17 clinical sites in the Veterans Health Administration health system about their experiences with a population health dashboard for anticoagulant management. Interview transcripts were coded using constructs from the Consolidated Framework for Implementation Research (CFIR) and according to the phase of implementation (pre-implementation, implementation, and sustainment) as defined by the VA Quality Enhancement Research Initiative (QUERI) Roadmap. We analyzed the factors that may determine successful implementation by examining the co-occurrence patterns between available resources and implementation climate across different implementation phases. To illustrate the variations in these determinants across phases, we aggregated and scored coded statements using a previously published CFIR scoring system (- 2 to + 2). Key relationships between available resources and implementation climate were identified and summarized using thematic analysis. RESULTS The resources necessary to support the successful implementation of an intervention are not static; both the quantity and types of resources shift based on the phases of the intervention. Furthermore, increased resource availability does not guarantee the sustainment of intervention success. Users need different types of support beyond the technical aspects of an intervention, and this support varies over time. Specifically, available resources in the form of technological support and social/emotional support help users establish trust in a new technological-based intervention during the implementation phase. Resources that foster and maintain collaboration between users and other stakeholders help them stay motivated during sustainment. CONCLUSIONS Our findings highlight the dynamic nature of available resources and their impacts on the implementation climate across different phases of implementation. A better understanding of the dynamics of available resources over time from the users' perspectives will allow the adaptation of resources to better meet the needs of the intervention stakeholders.
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Affiliation(s)
- Ying-Jen Lin
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Allison Ranusch
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - F Jacob Seagull
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy B Sussman
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey D Barnes
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI, 48109-2800, USA.
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Damschroder LJ, Sussman JB, Pfeiffer PN, Kurlander JE, Freitag MB, Robinson CH, Spoutz P, Christopher MLD, Battar S, Dickerson K, Sedgwick C, Wallace-Lacey AG, Barnes GD, Linsky AM, Ulmer CS, Lowery JC. Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients. Implement Sci Commun 2022; 3:53. [PMID: 35568903 PMCID: PMC9107220 DOI: 10.1186/s43058-022-00297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies. Methods For each trial, we will recruit 8–12 clinics (24–36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently. Discussion MIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings. Trial registration ClinicalTrials.gov: NCT05065502. Registered October 4, 2021—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00297-z.
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Affiliation(s)
- Laura J Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
| | - Jeremy B Sussman
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Paul N Pfeiffer
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jacob E Kurlander
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Michelle B Freitag
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Claire H Robinson
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Patrick Spoutz
- Veterans Health Affairs VISN 20 Pharmacy Benefits Management, Vancouver, WA, USA
| | - Melissa L D Christopher
- Pharmacy Benefits Management Services, Veterans Health Administration, 810 Vermont Ave NW, Washington DC, 20420, USA
| | - Saraswathy Battar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | | | - Christopher Sedgwick
- Department of Veterans Affairs, VA Heartland Network (VISN 15), Kansas City, MO, USA
| | | | - Geoffrey D Barnes
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Amy M Linsky
- Section of General Medicine, VA Boston Healthcare System, Boston, MA, USA.,Center for Health Organizations and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christi S Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Julie C Lowery
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
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Barnes GD, Sippola E, Ranusch A, Takamine L, Lanham M, Dorsch M, Sales A, Sussman J. Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process. Implement Sci Commun 2022; 3:10. [PMID: 35109916 PMCID: PMC8812192 DOI: 10.1186/s43058-022-00262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Facilitating appropriate care delivery using electronic health record (digital health) tools is increasing. However, frequently used determinants frameworks seldom address key barriers for technology-associated implementation. METHODS Semi-structured interviews were conducted in two contexts: the national Veterans Health Affairs (VA) following implementation of an electronic dashboard, a population health tool, and the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) prior to implementation of a similar electronic dashboard. The dashboard is designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians We performed rapid qualitative inquiry analysis and selected implementation strategies. Through a stakeholder focus group session, we selected implementation strategies to address determinants and facilitate implementation in the MAQI2 sites. RESULTS Among 45 interviewees (32 in VA, 13 in MAQI2), we identified five key determinants of implementation success: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about information technology support and prioritization within MAQI2 (prior to implementation) but not VA (after implementation) and concerns about authority and autonomy that differed between the VA (higher baseline levels, more concerns) and MAQI2 (lower baseline levels, less concern). CONCLUSIONS The successful implementation of electronic health record tools requires unique considerations that differ from other types of implementation, must account for the status of implementation, and should address the effects of the tool deployment on clinical staff authority and autonomy. Interviewing both post-implementation and pre-implementation users can provide a robust understanding of implementation determinants.
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Affiliation(s)
- Geoffrey D Barnes
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI, 48109-2800, USA. .,Center for Behavioral and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.
| | - Emily Sippola
- Center for Behavioral and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA
| | - Allison Ranusch
- Center for Clinical Management Research, Ann Arbor Veterans Health Affairs, Ann Arbor, USA
| | - Linda Takamine
- Center for Clinical Management Research, Ann Arbor Veterans Health Affairs, Ann Arbor, USA
| | - Michael Lanham
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, USA
| | - Michael Dorsch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.,College of Pharmacy, University of Michigan, Ann Arbor, USA
| | - Anne Sales
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.,Center for Clinical Management Research, Ann Arbor Veterans Health Affairs, Ann Arbor, USA.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, USA
| | - Jeremy Sussman
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.,Center for Clinical Management Research, Ann Arbor Veterans Health Affairs, Ann Arbor, USA.,Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
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7
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Dietrich E, Davis K, Talana A, Holland N, Akhavan N, Panna D, Wright A, Huber K. Three‐year clinical interventions from an outpatient multidisciplinary direct oral anticoagulant monitoring service. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eric Dietrich
- University of Florida College of Pharmacy, Gainesville Florida
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Kyle Davis
- United Therapeutics, Durham North Carolina
| | - Amy Talana
- Center for Living Well, Kissimmee Florida
| | - Neal Holland
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Neeka Akhavan
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Danielle Panna
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Ashleigh Wright
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Katherine Huber
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
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8
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Allen AL, Lucas J, Parra D, Spoutz P, Kibert JL, Ragheb B, Chia L, Sipe A. Shifting the Paradigm: A Population Health Approach to the Management of Direct Oral Anticoagulants. J Am Heart Assoc 2021; 10:e022758. [PMID: 34796718 PMCID: PMC9075229 DOI: 10.1161/jaha.121.022758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past decade, direct oral anticoagulants (DOACs) have contributed to a major paradigm shift in thrombosis management, replacing vitamin K antagonists as the most commonly prescribed anticoagulants in many countries. While DOACs provide distinct advantages over warfarin (eg, convenience, simplicity, and safety), they are frequently associated with inappropriate prescribing and adverse events. These events have prompted regulatory agencies to mandate oversight, which individual institutions may find difficult to comply with given limited resources. Veterans Health Administration (VHA) has leveraged technology to develop the DOAC Population Management Tool (PMT) to address these challenges. This tool has empowered VHA to update a 60‐year standard of care from one‐to‐one provider‐to‐patient anticoagulation monitoring to a population‐based management approach. The DOAC PMT allows for the oversight of all patients prescribed DOACs and leads to intervention only when clinically indicated. Using the DOAC PMT, facilities across VHA have maximized DOAC oversight while minimizing resource usage. Herein, we discuss how the DOAC PMT was conceived, developed, and implemented, along with the challenges encountered throughout the process. Additionally, we share the impact of the DOAC PMT across VHA, and the potential of this approach beyond anticoagulation and VHA.
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Affiliation(s)
- Arthur L Allen
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT
| | - Jessica Lucas
- North Florida/South Georgia Veterans Affairs Health Care System Gainesville FL
| | - David Parra
- Pharmacy Benefits Management Veterans Integrated Service Network 8 Bay Pines FL.,University of Minnesota College of Pharmacy Minneapolis MN
| | - Patrick Spoutz
- Pharmacy Benefits Management Veterans Integrated Service Network 20 Vancouver WA
| | | | - Bishoy Ragheb
- Veterans Affairs Tennessee Valley Health System Murfreesboro TN
| | - Linda Chia
- Pharmacy Benefits Management Veterans Integrated Service Network 8 Bay Pines FL
| | - Amy Sipe
- Academic Detailing Veterans Integrated Service Network 15 Kansas City MO
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