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Researchers measure quality of care in oral anticoagulation
Date:1/3/2011

(Boston) - Researchers from Boston University School of Medicine (BUSM) and the Bedford VA Medical Center believe that risk-adjusted percent time in therapeutic range (TTR) should be used as part of an effort to improve anticoagulation control and thus improve patient outcomes. These findings appear in this month's issue of Circulation: Cardiovascular Quality and Outcomes.

Oral anticoagulation with warfarin is received by millions of Americans each year to treat blood clots and to prevent strokes. While warfarin is effective, it is difficult to thin a patient's blood enough to protect them while avoiding dangerous over-anticoagulation. Excessive anticoagulation may result in serious or even fatal bleeding, particularly bleeding around the brain. Inadequate anticoagulation leaves the patient vulnerable to the events (such as stroke) that warfarin is used to prevent.

Previous studies have shown that better anticoagulation control can prevent many of these adverse events. "We have known for many years that anticoagulation control needs improvement, however, there has been no concerted effort to profile sites of care on anticoagulation control, as measured by percent time in therapeutic range," said lead author Adam Rose, MD, MSc, an assistant professor of medicine at BUSM and investigator at the Bedford VA Medical Center.

In addition, performance profiling can be complex, because some sites treat more challenging patient populations than others. Without adjusting for such complexity, they cannot know whether differences in site-level performance are due to the quality of care or the patient population. A model that adjusts for complexity is commonly called a "risk-adjustment model," and results that have been adjusted in this way are called "risk-adjusted results."

The researchers profiled 100 sites of care within the Veterans Health Administration using risk-adjusted TTR. According to them, the main findings of the s
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Contact: Gina DiGravio
gina.digravio@bmc.org
617-638-8480
Boston University Medical Center
Source:Eurekalert

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