Comparing Effectiveness Between Departments of Initiatives to Improve Stroke Prevention for Atrial Fibrillation Patients

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Publication Date

4-20-2017

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Advisor:

MR Cooper, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA

Abstract

The use of anticoagulants in patients with atrial fibrillation (AF) can reduce the risk of stroke, but the rates of anticoagulant use at Jefferson University hospital were not previously monitored. Direct oral anticoagulants (DOACs) are an alternative to warfarin for anticoagulation, having the benefit of higher stroke prevention, lower bleeding rates and less frequent blood work. The goal for this study was to measure anticoagulation rates and DOAC utilization and then design an intervention to improve both of these parameters. Through mining of the AllScripts ambulatory electronic health record (EHR), the rates of anticoagulation and choice of anticoagulant in AF patients by provider in the departments of Internal Medicine, Family Medicine and Cardiology were obtained. An educational intervention was designed based on the results of a survey of providers. Clinicians were provided their individual rates of anticoagulation and further information about DOACs, falls risk, and risk calculation for AF patients. The results of this intervention were an increase in the rate of anticoagulation in the department of Cardiology (from 75.7% to 81%), while Internal Medicine (74%) and Family Medicine (66.7%) remained unchanged. The rate of DOAC utilization increased in Internal Medicine (46.4% to 53%), Family Medicine (32% to 42%) and Cardiology (36% to 49%). Improving anticoagulation rates and utilization of DOACs in AF patients is possible by providing performance data to clinicians and creating targeted educational interventions. As the Jefferson transition to Epic EHR occurs, collection of advanced AF and anticoagulation data will expand and the quality improvement efforts will become more refined.

Presentation: 42:48

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