time in therapeutic inr range a quality assessment of anticoagulation management
DESCRIPTION
TIME IN THERAPEUTIC INR RANGE A Quality Assessment of Anticoagulation Management. Ann McBride, MD February 13, 2008. No financial disclosures. OBJECTIVE To understand use of TTR as quality assessment tool for anticoagulation management. - PowerPoint PPT PresentationTRANSCRIPT
TIME IN THERAPEUTIC INR RANGE
A Quality Assessment of Anticoagulation
Management
Ann McBride, MDFebruary 13, 2008
No financial disclosures
OBJECTIVE
• To understand use of TTR as quality assessment tool for anticoagulation management.
To discuss results of UW Anticoagulation Clinic
Quality Assessment using TTR
TIME IN THERAPEUTIC RANGE
• One tool to measure quality of anticoagulation management
• Correlates with fewer adverse outcomes Fewer thromboembolic events
(subtherapeutic INR)
• Fewer hemorrhagic events
(supratherapeutic INR)
TTR
• “Usual Care”
Through physician’s office 35-60%
• Anticoagulation Clinic/Anticoagulation
Management Service 40-65%
UW Anticoagulation Clinic
Pharmacist managed
Point-of-Care testing and management
Telephone managed patients
PCFDP Fall 2007 Project
• Determine Time in Therapeutic Range for
UW Anticoagulation Clinic Patients
TTR MEASUREMENT
• Chart Review 216/300+ patients
(currently follow approx 400 pts)
• INR for 2/15/07, 5/15/07
-Exclusion if recent interruption of
-warfarin, i.e., bridging or hospitalization
DEMOGRAPHICS
• Age
• Gender
• Indication
• Complexity of Medical Condition
i.e., number of medications
• Clinic Site
Gender
• 124/216 = males• 92/216=females
42.6
57.4
MaleFemale
AGE
50,less
50-60
60-70
70-80
80, older
11
25
15
24
25
INDICATIONS
• Atrial Fibrillation
• VTE
• MHV
• Other
TIA, CVA, PVD, cryptogenic stroke,
ventricular aneurysm, L atrial/vent
thrombus
INDICATIONS
• A Fib 117(+2)• VTE 55• MHV 24 (+2)• Other 18
54
25
11
8
A Fib
VTE
MHV
Other
Complexity of Medical Condition
# of meds• 5 or less• 6-10• 11-15• Greater than 16
16
32
30
22
5, less
6-10
11-15
16, greater
71.2 67.1
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR
TTR
• n = 198, 213
ATRIAL FIB
64.569.5
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR
• n = 110, 115
VTE
60.7 58
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR
• n = 51, 55
MHV
71.466.7
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR
• n = 21, 24
OTHER
83.3
47
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR
• n = 18, 17
COMPLEXITY OF MEDICAL CONDITION
• Less than 5 Rx meds
73.560
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR7
• n = 34, 35
COMPLEXITY of MEDICAL CONDITION
• 6-10 Rx Meds
59.472
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR
• n = 69, 68
COMPLEXITY of MEDICAL CONDITION
• 11-15 Rx meds
65.571.8
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR
• n = 61, 64
COMPLEXITY of MEDICALCONDITION
• 16 or more Rx meds
43.8
65.2
0102030405060708090
100
Feb-07 Mar-07 Apr-07 May-07
% TTR
• n = 42, 46
SITE• U STATION n = 134,146• WEST n = 62,70
70.162.9 63.0 62.8
0102030405060708090
100
2/15 U
2/15 W
5/15 U
5/15 W
% TTR
CONCLUSION
Opportunity to appreciate demographics and complexity of pts
Performance higher end of range for AMS. Afib & MHV pts have greater TTR. Increased
TTR for older, afib pts may reflect less variation of diet, exercise, & routine.
Consider patient population/selection