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dc.contributor.authorRose, Adam J.
dc.contributor.authorHylek, Elaine M.
dc.contributor.authorOzonoff, Al
dc.contributor.authorAsh, Arlene S.
dc.contributor.authorReisman, Joel I.
dc.contributor.authorCallahan, Patricia P.
dc.contributor.authorGordon, Margaret M.
dc.contributor.authorBerlowitz, Dan R.
dc.date2022-08-11T08:10:33.000
dc.date.accessioned2022-08-23T17:12:36Z
dc.date.available2022-08-23T17:12:36Z
dc.date.issued2011-04-01
dc.date.submitted2012-05-16
dc.identifier.citationAm J Manag Care. 2011 Apr;17(4):284-9.
dc.identifier.issn1088-0224 (Linking)
dc.identifier.pmid21615198
dc.identifier.urihttp://hdl.handle.net/20.500.14038/46539
dc.description.abstractOBJECTIVE: To describe variations in the structure of anticoagulation clinic (ACC) care within the Veterans Health Administration (VA) and to identify structures of care that are associated with better site-level anticoagulation control. STUDY DESIGN: Questionnaire correlated with automated clinical data. METHODS: We characterized 90 VA ACCs using a questionnaire administered by the VA Central Office. Site descriptors included staffing levels, provider training, visit modalities, quality improvement programs, documentation, and care coordination. Patient outcomes were measured by site mean risk-adjusted percentage time in therapeutic range, a measure of anticoagulation control over time. Our study was powered to detect a 3% difference in risk-adjusted percentage time in therapeutic range, a small-to-moderate effect size, between sites with and without a certain characteristic. RESULTS: We observed considerable variation in the structure of ACC care. For example, 48 sites had fewer than 400 patients per provider, 25 sites had 400 to 599 patients per provider, and 17 sites had 600 patients or more per provider. However, none of the site characteristics measured were significantly related to anticoagulation control. CONCLUSIONS: We found substantial variation in guideline-targeted organizational and management features of ACC care within the VA. However, no single feature was associated with better anticoagulation control. Current guidelines for organizing an ACC may have limited relevance for improving patient outcomes.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=21615198&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://www.ajmc.com/publications/issue/2011/2011-4-vol17-n4/AJMC_11apr_Rose_284to289/
dc.subjectAdministration, Oral
dc.subjectAmbulatory Care Facilities
dc.subjectAnticoagulants
dc.subjectHospitals, Veterans
dc.subjectHumans
dc.subjectInternational Normalized Ratio
dc.subjectPharmacy Service, Hospital
dc.subject*Practice Guidelines as Topic
dc.subject*Quality Improvement
dc.subjectQuestionnaires
dc.subjectUnited States
dc.subjectUnited States Department of Veterans Affairs
dc.subjectWarfarin
dc.subjectBiostatistics
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleRelevance of current guidelines for organizing an anticoagulation clinic
dc.typeJournal Article
dc.source.journaltitleThe American journal of managed care
dc.source.volume17
dc.source.issue4
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/1006
dc.identifier.contextkey2852741
html.description.abstract<p>OBJECTIVE: To describe variations in the structure of anticoagulation clinic (ACC) care within the Veterans Health Administration (VA) and to identify structures of care that are associated with better site-level anticoagulation control.</p> <p>STUDY DESIGN: Questionnaire correlated with automated clinical data.</p> <p>METHODS: We characterized 90 VA ACCs using a questionnaire administered by the VA Central Office. Site descriptors included staffing levels, provider training, visit modalities, quality improvement programs, documentation, and care coordination. Patient outcomes were measured by site mean risk-adjusted percentage time in therapeutic range, a measure of anticoagulation control over time. Our study was powered to detect a 3% difference in risk-adjusted percentage time in therapeutic range, a small-to-moderate effect size, between sites with and without a certain characteristic.</p> <p>RESULTS: We observed considerable variation in the structure of ACC care. For example, 48 sites had fewer than 400 patients per provider, 25 sites had 400 to 599 patients per provider, and 17 sites had 600 patients or more per provider. However, none of the site characteristics measured were significantly related to anticoagulation control.</p> <p>CONCLUSIONS: We found substantial variation in guideline-targeted organizational and management features of ACC care within the VA. However, no single feature was associated with better anticoagulation control. Current guidelines for organizing an ACC may have limited relevance for improving patient outcomes.</p>
dc.identifier.submissionpathqhs_pp/1006
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages284-9


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