title: Effects of anticoagulation provider continuity on time in therapeutic range for warfarin patients.
abstract: Anticoagulation (AC) clinics use the percentage of time in the therapeutic INR range (%TTR) to characterize the quality of management for patients treated with warfarin. In order to guide policy and procedure changes, the purpose of this quality improvement (QI) study was to characterize the AC patient population at The Johns Hopkins Hospital (JHH). We set out to investigate the impact of AC clinic provider continuity on the quality of anticoagulation management. This QI study is a retrospective chart review of 525 warfarin patients managed by pharmacists in the Hematology AC Management Clinic at JHH from June 28, 2013 to November 1, 2014. We recorded patient demographic and clinical characteristics and the quality of AC management using %TTR, and compared these parameters between patients with (Group A) and without a primary AC (Group B). Group A patients had a significantly higher %TTR than Group B patients (53.2 vs. 46.5 %, p = 0.008). In conclusion, we found that patients with a primary AC clinic provider had a higher %TTR than patients with multiple providers. If confirmed prospectively, this approach to warfarin management could represent one technique for AC clinics to optimize patient management and clinical outcomes.
authors.affiliation: Division of Ambulatory and Care Transitions, Department of Pharmacy, The Johns Hopkins Hospital, 600 N. Wolfe Street, Carnegie 180, Baltimore, MD, 21287, USA. martinbishop@jhmi.edu.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Bishop
authors.affiliation: Departments of Medicine and Pathology, Johns Hopkins University School of Medicine, 1830 Monument Street, Suite 7300, Baltimore, MD, 21205, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D019468:Disease Management; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D019934:International Normalized Ratio; D010595:Pharmacists / Q000706:statistics & numerical data; D011786:Quality Control; D012189:Retrospective Studies; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Anticoagulants; International normalized ratio; Quality improvement; Venous thromboembolism; Warfarin