Gaps in monitoring during oral anticoagulation: insights into care transitions, monitoring barriers, and medication nonadherence

Show simplified metadata
dc.contributor.authorRose, Adam J.
dc.contributor.authorMiller, Donald R.
dc.contributor.authorOzonoff, Al
dc.contributor.authorBerlowitz, Dan R.
dc.contributor.authorAsh, Arlene S.
dc.contributor.authorZhao, Shibei
dc.contributor.authorReisman, Joel I.
dc.contributor.authorHylek, Elaine M.
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.date2022-08-11T08:10:34.000
dc.date.accessioned2022-08-23T17:13:02Z
dc.date.available2022-08-23T17:13:02Z
dc.date.issued2013-03-01
dc.date.submitted2013-04-10
dc.description.abstractBACKGROUND: Among patients receiving oral anticoagulation, a gap of andgt; 56 days between international normalized ratio tests suggests loss to follow-up that could lead to poor anticoagulation control and serious adverse events. METHODS: We studied long-term oral anticoagulation care for 56,490 patients aged 65 years and older at 100 sites of care in the Veterans Health Administration. We used the rate of gaps in monitoring per patient-year to predict percentage time in therapeutic range (TTR) at the 100 sites. RESULTS: Many patients (45%) had at least one gap in monitoring during an average of 1.6 years of observation; 5% had two or more gaps per year. The median gap duration was 74 days (interquartile range, 62-107). The average TTR for patients with two or more gaps per year was 10 percentage points lower than for patients without gaps (P andlt; .001). Patient-level predictors of gaps included nonwhite race, area poverty, greater distance from care, dementia, and major depression. Site-level gaps per patient-year varied from 0.19 to 1.78; each one-unit increase was associated with a 9.2 percentage point decrease in site-level TTR (P andlt; .001). CONCLUSIONS: Site-level gap rates varied widely within an integrated care system. Sites with more gaps per patient-year had worse anticoagulation control. Strategies to address and reduce gaps in monitoring may improve anticoagulation control.
dc.identifier.citationChest. 2013 Mar 1;143(3):751-7. doi: 10.1378/chest.12-1119. <a href="http://dx.doi.org/10.1378/chest.12-1119" target="_blank">Link to article on publisher's site</a>
dc.identifier.contextkey4020102
dc.identifier.doi10.1378/chest.12-1119
dc.identifier.issn0012-3692 (Linking)
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/1099
dc.identifier.pmid23187457
dc.identifier.submissionpathqhs_pp/1099
dc.identifier.urihttps://hdl.handle.net/20.500.14038/46637
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=23187457&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1378/chest.12-1119
dc.source.issue3
dc.source.journaltitleChest
dc.source.pages751-7
dc.source.volume143
dc.subjectBiostatistics
dc.subjectCardiology
dc.subjectCardiovascular Diseases
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleGaps in monitoring during oral anticoagulation: insights into care transitions, monitoring barriers, and medication nonadherence
dc.typeJournal Article
dspace.entity.typePublication
html.description.abstract<p>BACKGROUND: Among patients receiving oral anticoagulation, a gap of andgt; 56 days between international normalized ratio tests suggests loss to follow-up that could lead to poor anticoagulation control and serious adverse events.</p> <p>METHODS: We studied long-term oral anticoagulation care for 56,490 patients aged 65 years and older at 100 sites of care in the Veterans Health Administration. We used the rate of gaps in monitoring per patient-year to predict percentage time in therapeutic range (TTR) at the 100 sites.</p> <p>RESULTS: Many patients (45%) had at least one gap in monitoring during an average of 1.6 years of observation; 5% had two or more gaps per year. The median gap duration was 74 days (interquartile range, 62-107). The average TTR for patients with two or more gaps per year was 10 percentage points lower than for patients without gaps (P andlt; .001). Patient-level predictors of gaps included nonwhite race, area poverty, greater distance from care, dementia, and major depression. Site-level gaps per patient-year varied from 0.19 to 1.78; each one-unit increase was associated with a 9.2 percentage point decrease in site-level TTR (P andlt; .001).</p> <p>CONCLUSIONS: Site-level gap rates varied widely within an integrated care system. Sites with more gaps per patient-year had worse anticoagulation control. Strategies to address and reduce gaps in monitoring may improve anticoagulation control.</p>
Files
Collections
Population and Quantitative Health Sciences Publications