Navigation Links
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 study are threefold. First, TTR varied widely among VA anticoagulation clinics, from 38 percent time in range to 69 percent, or from poor to excellent control. This suggests that some VA sites are already doing very well with this area of care, while others need to improve. Second, while risk-adjustment did not alter performance rankings for many sites, for other sites it made an important difference. For example, the anticoagulation clinic that was ranked 27th out of 100 before risk adjustment was ranked as one of the best (7th) after risk-adjustment. This demonstrates the importance of adjusting TTR for case mix when profiling performance. Third, site performance on risk-adjusted TTR was consistent from year to year, suggesting that risk-adjusted TTR measures a construct (quality of care) that is stable over time, rather than mere statistical variation.

"Our study suggests that risk-adjusted TTR should be considered for more widespread use as a performance measure as part of an effort to improve anticoagulation control and thus improve patient outcomes, said Rose. "In the past, the VA has led efforts to measure and improve quality in other areas of care, and numerous studies have shown that the VA delivers care that is as good as or better than non-VA care. We plan to make the VA a leader in delivering high-quality anticoagulation care as well," he added. The authors note that profiling anticoagulation performance is within the reach of any integrated health care system.

"As a nation, we spend vast amounts of effort and resources profiling performance regarding diabetes, blood pressure, acute coronary syndromes, cancer screening, and commonly performed surgeries," explained Rose. "Until now, we have not tried to profile performance regarding anticoagulation control. This study suggests that we can - and we should."


'/>"/>

Contact: Gina DiGravio
gina.digravio@bmc.org
617-638-8480
Boston University Medical Center
Source:Eurekalert

Related medicine news :

1. U.S. Researchers Find New Way to Gauge Rare Genetic Condition
2. Researchers Find Links Between Sleep, Anesthesia and Coma
3. Researchers: Pay more attention to epilepsy
4. UCLA researchers uncover new cell biological mechanism that regulates protein stability in cells
5. Mount Sinai researchers make major breakthrough in melanoma research
6. Penn researchers identify potential target for breast cancer therapy
7. Researchers Turn White Fat to Energy-Burning Brown Fat in Mice
8. Finnish researchers find a compound that prevents the growth of prostate cancer cells
9. Ben-Gurion U. researchers: High resistance rates among acute otitis media pathogens in children
10. Breast inflammation is key to cancer growth, Kimmel Cancer Center researchers say
11. Researchers discover new signaling pathway linked to inflammatory disease
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/8/2016)... Park, KS (PRWEB) , ... February 08, 2016 , ... ... a leader in Mole removal products. , Moles are derived from a cluster of ... appear in all the wrong places and create a lifetime of embarrassment. Historically, ...
(Date:2/8/2016)... ... , ... Guruji Mahendra Kumar Trivedi is offering 3 days of accelerated personal ... birthday on February 10th. During this time, people can achieve better health, greater ... people from over 40 different countries as an “ordinary man with an extraordinary gift.” ...
(Date:2/8/2016)... ... ... According to research by the National Association of Dental ... certified or obtain continuing education. To increase patient awareness of the lack of ... to inform dentists and patients about the possible lack of skills and knowledge ...
(Date:2/7/2016)... (PRWEB) , ... February 07, 2016 , ... Women's Excellence ... National Wear Red Day. National Wear Red Day is the first Friday each ... Heart disease and stroke cause 1 in 3 deaths among women each year – ...
(Date:2/7/2016)... AZ (PRWEB) , ... February 07, 2016 , ... ... Neck and Facial Plastics, has added Kybella® to his medical and surgical expertise. ... a newly approved FDA injectable medication used as a non-surgical alternative for reduction ...
Breaking Medicine News(10 mins):
(Date:2/8/2016)... India , February 8, 2016 ... a new market research report "Ablation Technologies Market by ... (Csardiovascular, Cancer, Pain Management, Cosmetic Surgery, Ophthalmology, Gynecology) - ... studies the global market over the forecast period of ... $4.44 Billion by 2020, at CAGR of 10.5% from ...
(Date:2/8/2016)... Kan. , Feb. 8, 2016 /PRNewswire/ ... organization that formerly specialized in the development ... recently announced that it has divided its ... Capital. While Nueterra Capital will continue the ... services, NueHealth will operate a national system ...
(Date:2/8/2016)... , Feb. 8, 2016  A research team ... scientists has discovered details of how the abnormal breakage ... a particularly aggressive form of acute lymphoblastic leukemia (ALL). ... which genetic mutations trigger overproduction of immature cells, called ... The discoveries of the malfunction underlying the type called ...
Breaking Medicine Technology: