title: Improving Warfarin Management Within the Medical Home: A Health-System Approach.
abstract: BACKGROUND
  Anticoagulation clinics have been considered the optimal strategy for warfarin management with demonstrated improved patient outcomes through increased time in therapeutic international normalized ratio (INR) range, decreased critical INR values, and decreased anticoagulation-related adverse events. However, not all health systems are able to support a specialized anticoagulation clinic or may see patient volume exceed available anticoagulation clinic resources. The purpose of this study was to utilize an anticoagulation clinic model to standardize warfarin management in a primary care clinic setting.
  
  
  METHODS
  A warfarin management program was developed that included standardized patient assessment, protocolized warfarin-dosing algorithm, and electronic documentation and reporting tools. Primary care clinics were targeted for training and implementation of this program.
  
  
  RESULTS
  The warfarin management program was applied to over 2000 patients and implemented at 39 clinic sites. A total of 160 nurses and 15 pharmacists were trained on the program. Documentation of warfarin dose and date of the next INR increased from 70% to 90% (P <.0001), documentation occurring within 24 hours of the INR result increased from 75% to 87% (P <.0001), and monitoring the INR at least every 4 weeks increased from 71% to 83% (P <.0001) per patient encounter. Time in therapeutic INR range improved from 65% to 75%.
  
  
  CONCLUSIONS
  Incorporating a standardized approach to warfarin management in the primary care setting significantly improves warfarin-related documentation and time in therapeutic INR range.
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Electronic address: arose@uwhealth.org.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Rose
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Robinson
authors.affiliation: University of Wisconsin Medical Foundation, Madison.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Premo
authors.affiliation: University of Wisconsin Medical Foundation, Madison.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Hauschild
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Trapskin
authors.affiliation: Department of Medicine, University of Wisconsin Medical Foundation, Madison.
authors.forename: Ann M
authors.initials: AM
authors.lastname: McBride
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002985:Clinical Protocols; D004282:Documentation; D057286:Electronic Health Records / Q000458:organization & administration; D005260:Female; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000379:methods* / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Anticoagulants; Patient-centered care; Primary health care; Warfarin