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Publication Briefs

Study Proposes Research Agenda for Oral Anticoagulation Quality Measurement

Oral anticoagulation with warfarin is an increasingly common medical intervention; yet despite its efficacy, it is notoriously difficult to manage. Efforts to measure the quality of oral anticoagulation care have focused disproportionately on the identification of ideal candidates for warfarin therapy, with little effort in measuring the quality of oral anticoagulation once therapy has begun. To address this knowledge gap, investigators in this study conducted a literature search to identify quality measures. They then discuss what is known about candidate quality measures, and propose a research agenda to advance our understanding of how to measure the quality of care in oral anticoagulation.

Candidate quality measures include: structural measures (i.e., one setting vs. another), process measures (i.e., providing optimal care to the correct patient in a timely fashion), intermediate outcomes (i.e., time in therapeutic INR range), and definitive outcomes (i.e., thromboembolism, major bleeding). Investigators also identify 11 research goals to advance quality measurement in oral anticoagulation, addressing these quality measures. For instance, regarding 'structure of care,' research goals include: 1) document relationship between site volume and outcomes in anticoagulation clinics (ACCs); 2) document the effect of staff-to-patient ratio on outcomes in an ACC; and 3) describe aspects of ACC organizational management or leadership that contribute to outcomes. Authors propose that valid quality indicators will provide a framework for quality improvement that will maximize the effectiveness of therapy and minimize patient harm.

PubMed Logo Rose A, Berlowitz D, Frayne S, and Hylek E. Measuring quality of oral anticoagulation care: Extending quality measurement to a new field. The Joint Commission Journal on Quality and Patient Safety March 2009;35(3):146-155.

Dr. Rose was supported by an HSR&D Career Development Award. Drs. Rose and Berlowitz are part of HSR&D's Center for Health Quality, Outcomes, and Economic Research; Dr. Frayne is part of HSR&D's Center for Health Care Evaluation.

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