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Engaging with quality improvement in anticoagulation management

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Abstract

Anticoagulants are highly effective at preventing thrombosis across a variety of clinical indications. However, their use can also lead to devastating effects, including major bleeding and death. Anticoagulation providers strive to balance the benefits of anticoagulant therapy with the risks of major bleeding. A measure of quality care can be used to assess the strengths and potential weaknesses in any system of coordinated care delivery. Quality measures in anticoagulation include patient-centered outcomes (e.g. major bleeding, time in the therapeutic range) and provider- or process-focused outcomes (e.g. compliance with guideline recommendations and response times to out-of-range laboratory values). Engaging in quality improvement activities allows anticoagulation providers to assess their own performance and identify areas for targeted interventions. This review summarizes the justification for engaging in quality improvement for anticoagulation management and describes a number of example programs. Interventions benefiting the management of both warfarin and the direct oral anticoagulants are included. The review also details potential quality measures and resources for any anticoagulation provider looking to begin a quality improvement process.

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Acknowledgments

The authors wish to acknowledge Scott Kaatz, DO, MSc for his insightful contributions in the development and review of this document.

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Authors and Affiliations

  1. University of Michigan Cardiovascular Center (UM CVC), Domino’s Farms, Lobby A, MCORRP, 24 Frank Lloyd Wright Dr., Ann Arbor, MI, 48106, USA

    Geoffrey D. Barnes & Eva Kline-Rogers

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  1. Geoffrey D. Barnes
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  2. Eva Kline-Rogers
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Correspondence to Geoffrey D. Barnes.

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Barnes, G.D., Kline-Rogers, E. Engaging with quality improvement in anticoagulation management. J Thromb Thrombolysis 39, 403–409 (2015). https://doi.org/10.1007/s11239-015-1184-8

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