title: A non-experimental study of oral anticoagulation therapy initiation before and after national patient safety goals.
abstract: OBJECTIVE
  The Joint Commission revised its National Patient Safety Goals (NPSGs) to include oral anticoagulation therapy (OAT) in 2008. We sought to examine the effect of including OAT in The Joint Commission's NPSGs on historically low rates of OAT initiation for individuals with incident atrial fibrillation (AF).
  
  
  METHODS
  Southeastern state in the USA.
  
  
  METHODS
  North Carolina State Health Plan claims data from 944 500 individuals enrolled between 1 January 2006 and 31 December 2010, supplemented with data from the Area Resource File and Online Survey, Certification and Reporting data network. We evaluated OAT initiation before and after the 2008 NPSGs revisions in a retrospective cohort new user design with an AF intervention group and two control groups: a positive control-patients estimated to be at very high risk of thromboembolism (mechanical heart valve and pulmonary embolism); and a negative control-patients with very low perceived risk of thromboembolism (paroxysmal AF). We developed multivariable models using a difference-in-difference parameterisation. Effects were estimated with generalised estimating equations.
  
  
  METHODS
  OAT initiation, a binary outcome defined as having a prescription drug claim for warfarin within 30 days of the index claim.
  
  
  RESULTS
  OAT initiation was low (26.8%) for eligible individuals with incident AF in 2006-2008 but increased after NPSGs implementation (31.7%, p=0.022). OAT initiation was high but decreased in the positive control group (67.5% vs 62.0%, p=0.003). Multivariate analysis resulted in a relative 11% (95% CI (4% to 18%), p<0.01) increase in OAT initiation for incident AF patients.
  
  
  CONCLUSIONS
  We document a substantial increase in guideline concordant OAT initiation in incident AF after the establishment of NPSGs, suggesting that regulatory healthcare agency initiatives can influence clinical practice.
authors: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Durham, North Carolina, USA.
authors: Christopher A
authors: CA
authors: Beadles
authors: Kristen
authors: K
authors: Hassmiller Lich
authors: Anthony J
authors: AJ
authors: Viera
authors: Sandra B
authors: SB
authors: Greene
authors: M Alan
authors: MA
authors: Brookhart
authors: Morris
authors: M
authors: Weinberger
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005260:Female; D006040:Goals; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D009657:North Carolina; D061214:Patient Safety; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control*; D014481:United States; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin