Prompt repeat testing after out-of-range inr values a quality indicator for anticoagulation care

Adam J. Rose, Elaine M. Hylek, Dan R. Berlowitz, Arlene S. Ash, Joel I. Reisman, Al Ozonoff

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

Background: Improved control of oral anticoagulation reduces adverse eventsA program of quality measurement is needed for oral anticoagulationThe interval until the next test after an out-of-range International Normalized Ratio (INR) value (the "follow-up interval") could serve as a process of care measureMethods and Results: We studied 104 451 patients cared for by 100 anticoagulation clinics in the Veterans Health Administration (VA)For each site, we computed the average follow-up interval after low (≤1.5) or high (≥4.0) INROur outcome was each site's average anticoagulation control, measured by percent time in therapeutic range (TTR); 59 837 patients (57%) contributed to the low INR analysis, 37 697 (36%) contributed to the high INR analysis, and all patients contributed to the dependent variable (mean site TTR)After a low INR, site mean follow-up interval ranged from 10 to 24 daysLonger follow-up intervals were associated with worse site-level control (1.04% lower for each additional day, P<0.001)After a high INR, site mean follow-up interval ranged from 6 to 18 days, with longer follow-up intervals associated with worse site-level control (1.12% lower for each additional day, P<0.001)These relationships were somewhat attenuated but still highly statistically significant when the proportion of INR values in-range was used as the dependent variable rather than TTRConclusions: Prompt repeat testing after out-of-range INR values is associated with better anticoagulation control at the site level and could be an important part of a quality improvement effort for oral anticoagulation

Original languageAmerican English
Pages (from-to)276-282
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume4
Issue number3
DOIs
StatePublished - May 2011
Externally publishedYes

Keywords

  • Ambulatory care
  • Anticoagulants
  • Medication therapy management
  • Quality of health care
  • Warfarin

Fingerprint

Dive into the research topics of 'Prompt repeat testing after out-of-range inr values a quality indicator for anticoagulation care'. Together they form a unique fingerprint.

Cite this