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TIME IN THERAPEUTIC INR RANGE A Quality Assessment of Anticoagulation Management

TIME IN THERAPEUTIC INR RANGE A Quality Assessment of Anticoagulation Management. Ann McBride, MD February 13, 2008. No financial disclosures. OBJECTIVE To understand use of TTR as quality assessment tool for anticoagulation management.

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TIME IN THERAPEUTIC INR RANGE A Quality Assessment of Anticoagulation Management

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  1. TIME IN THERAPEUTIC INR RANGEA Quality Assessment of AnticoagulationManagement Ann McBride, MD February 13, 2008

  2. No financial disclosures

  3. OBJECTIVE • To understand use of TTR as quality assessment tool for anticoagulation management. To discuss results of UW Anticoagulation Clinic Quality Assessment using TTR

  4. TIME IN THERAPEUTIC RANGE • One tool to measure quality of anticoagulation management • Correlates with fewer adverse outcomes Fewer thromboembolic events (subtherapeutic INR) • Fewer hemorrhagic events (supratherapeutic INR)

  5. TTR • “Usual Care” Through physician’s office 35-60% • Anticoagulation Clinic/Anticoagulation Management Service 40-65%

  6. UW Anticoagulation Clinic Pharmacist managed Point-of-Care testing and management Telephone managed patients

  7. PCFDP Fall 2007 Project • Determine Time in Therapeutic Range for UW Anticoagulation Clinic Patients

  8. TTR MEASUREMENT • Chart Review 216/300+ patients (currently follow approx 400 pts) • INR for 2/15/07, 5/15/07 -Exclusion if recent interruption of -warfarin, i.e., bridging or hospitalization

  9. DEMOGRAPHICS • Age • Gender • Indication • Complexity of Medical Condition i.e., number of medications • Clinic Site

  10. Gender • 124/216 = males • 92/216=females

  11. AGE

  12. INDICATIONS • Atrial Fibrillation • VTE • MHV • Other TIA, CVA, PVD, cryptogenic stroke, ventricular aneurysm, L atrial/vent thrombus

  13. INDICATIONS • A Fib 117(+2) • VTE 55 • MHV 24 (+2) • Other 18

  14. Complexity of Medical Condition # of meds • 5 or less • 6-10 • 11-15 • Greater than 16

  15. TTR • n = 198, 213

  16. ATRIAL FIB • n = 110, 115

  17. VTE • n = 51, 55

  18. MHV • n = 21, 24

  19. OTHER • n = 18, 17

  20. COMPLEXITY OF MEDICAL CONDITION • Less than 5 Rx meds • n = 34, 35

  21. COMPLEXITY of MEDICAL CONDITION • 6-10 Rx Meds • n = 69, 68

  22. COMPLEXITY of MEDICAL CONDITION • 11-15 Rx meds • n = 61, 64

  23. COMPLEXITY of MEDICALCONDITION • 16 or more Rx meds • n = 42, 46

  24. SITE • U STATION n = 134,146 • WEST n = 62,70

  25. CONCLUSION Opportunity to appreciate demographics and complexity of pts Performance higher end of range for AMS. Afib & MHV pts have greater TTR. Increased TTR for older, afib pts may reflect less variation of diet, exercise, & routine. Consider patient population/selection

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