title: Performance improvement in managed long-term care: improving warfarin medication management.
abstract: Oral anticoagulation therapy such as warfarin administration is of benefit for some groups of older adult patients. However, the increased risk for bleeding is of concern when warfarin is used in this population. This article describes interventions of a performance improvement initiative aimed at improving care management of members receiving warfarin therapy in a large managed long-term care program. These interventions significantly improved in terms of care outcomes including increased monitoring of the international normalized ratio (INR), communication with physicians when problems related to warfarin therapy arose, and education of members or caregivers about warfarin therapy.
authors.affiliation: VNS CHOICE, New York, NY, USA. donna.desmond@vnsny.org
authors.forename: Donna
authors.initials: D
authors.lastname: Desmond
authors.forename: Polina
authors.initials: P
authors.lastname: Kogan
authors.forename: Susan
authors.initials: S
authors.lastname: Underwood
authors.forename: Evelyn
authors.initials: E
authors.lastname: Brobbey
authors.forename: Patrick
authors.initials: P
authors.lastname: Luib
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D019090:Case Management / Q000458:organization & administration*; D016009:Chi-Square Distribution; D003142:Communication; D016903:Drug Monitoring; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D019934:International Normalized Ratio; D008134:Long-Term Care / Q000458:organization & administration*; D008297:Male; D020380:Needs Assessment; D009720:Nurse Clinicians; D015403:Nursing Evaluation Research; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D017749:Total Quality Management / Q000458:organization & administration*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin