title: Participant perspectives from the Indian Health Service Anticoagulation Training Program.
abstract: BACKGROUND
  The Indian Health Service Anticoagulation Training Program serves to improve patient safety through advanced anticoagulation management training. Although post-program evaluations of program content were conducted at the time of program delivery, little is known about translation of these learned skills into clinical practice.
  
  
  OBJECTIVE
  This research sought to describe levels of self-reported participant confidence in anticoagulation management; development, implementation, and performance management of both core and supplemental activities of anticoagulation clinics or services; and current anticoagulation clinical practices subsequent to participating in the Anticoagulation Training Program.
  
  
  METHODS
  A federal Indian Health Service healthcare facility in Oklahoma, USA.
  
  
  METHODS
  A cross-sectional, electronic mail survey was designed, pretested, and administered to 267 eligible Anticoagulation Training Program participants from 1999 to 2009. Data were analyzed using descriptive statistics and interpreted to identify areas of strength and opportunities for improvement.
  
  
  METHODS
  Information about confidence in anticoagulation management skills; development, implementation and improvement of both core and supplemental activities of anticoagulation clinics or services; and current anticoagulation clinical practices was collected.
  
  
  RESULTS
  After training, over 90 % of participants reported agreement/strong agreement with statements about confidence in performing patient-care related anticoagulation activities. A smaller proportion (83.3-85.4 %) reported agreement/strong agreement with confidence in measuring, analyzing and reporting anticoagulation outcomes. Improvement activities were more common than development or implementation activities (65.4, 31.9 and 35.1 %, respectively). Not having well established reimbursement procedures, lack of dedicated clinic space, and lack of dedicated personnel salaries (47.3, 38.3 and 32.6 %, respectively) were reported as the most common barriers to developing, implementing or improving an anticoagulation clinic. Participants indicated that anticoagulation outcomes tracking was the most common supplemental development, implementation and improvement activity (37.9, 37.0 and 43.8 % respectively). Benchmarking was the least commonly reported outcomes-related activity by participants (33.6 %). Although there was only a modest gain in the number of established anticoagulation clinics after attending the Anticoagulation Training Program, approximately 21 % of participants reported using skills learned to establish other disease state management clinics.
  
  
  CONCLUSIONS
  In general, a majority of participants reported high levels of confidence related to direct patient care activities after attending the Anticoagulation Training Program. However there is a need to raise confidence in performance improvement and outcomes management activities to align with current accreditation standards in anticoagulation management as the Anticoagulation Training Program evolves.
authors.affiliation: Claremore Comprehensive Health Care Facility, 101 South Moore Avenue, Claremore, OK, 74017, USA, ryan.schupbach@ihs.gov.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Schupbach
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Sparrow
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miller
authors.forename: Donald L
authors.initials: DL
authors.lastname: Harrison
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D019985:Benchmarking; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003625:Data Collection; D006801:Humans; D009825:Oklahoma; D017063:Outcome Assessment, Health Care; D016730:Program Development; D015397:Program Evaluation; D014481:United States; D016549:United States Indian Health Service
chemical_list: D000925:Anticoagulants
references.citation: J Nurs Educ. 2004 Apr;43(4):149-55
references.pmid: 15098908
references.citation: Arch Intern Med. 2005 May 23;165(10):1095-106
references.pmid: 15911722
references.citation: Psychol Rev. 1977 Mar;84(2):191-215
references.pmid: 847061
references.citation: J Interprof Care. 2008 Jun;22(3):295-307
references.pmid: 18569415
references.citation: Jt Comm J Qual Patient Saf. 2010 Jan;36(1):12-21
references.pmid: 20112660
references.citation: J Am Geriatr Soc. 2009 Apr;57(4):653-8
references.pmid: 19220563
references.citation: Arch Intern Med. 2002 Sep 9;162(16):1897-903
references.pmid: 12196090
references.citation: J Nurses Staff Dev. 2007 May-Jun;23(3):136-9
references.pmid: 17538268
references.citation: Circulation. 2009 Apr 21;119(15):e480-2
references.pmid: 19380627
references.citation: Chest. 2008 Jun;133(6 Suppl):160S-198S
references.pmid: 18574265